1990, 01-25 Permit App: 90000327 Plumbing Fixtures • a Y
PLUMBING PERMIT APPLICATION FORM
Information Worksheet •
JOB STREET ADDRESS: (�) 1 ) L < .N A V L W h t> X27
CITY/STATE/ZIP: )c IA-'ts. Ws4 PARCEL NUMBER:
OWNER: e tom S PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR:
`-- N- 1— N-4.--\c- LICENSE NUMBER: LL U,ti 1)-3
�g
PHONE NUMBER:
MAILING ADDRESS: irl0`l pL�oK'� K j c =- O 7
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS \ x $6.00 = (,_A o
SINKS k x 6. 00 = (, .,o d
SHOWERS 1 x 6. 00 =
BATH TUBS x 6. 00 =
KITCHEN SINKS x 6. 00 =
DISH WASHERS x 6. 00 =
GARBAGE DISPOSAL x 6.00 =
CLOTHES WASHER x 6. 00 =
UTILITY SINKS x 6.00 =
ELECTRIC WATER HEATERS x 6.00 =
FLOOR DRAINS x 6. 00 =
FLOOR SINKS x 6. 00 =
BAR SINKS x 6. 00 =
ROOF DRAINS x 6. 00 =
LAWN SPRINKLER x 6. 00 =
SEWAGE EJECTOR x 6. 00 =
WATER SOFTENER x 6. 00 =
URINAL x 6. 00 =
DRINKING FOUNTAIN x 6. 00 =
SUBTOTAL $ 1cZ..00
PLUS: PROCESSING FEE + $ 25. 00
1
EQUALS: TOTAL PERMITI
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE $ k-"-3_0o
I $
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (5 9) 456-3675