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1992, 05-22 Permit App: 92003661 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM 9.a- 3 ( InforrriAtion Worksheet (� —6 u \-1 JOB STREET ADDRESS:, / C.),_"5---- Z)4 A... (. DA—) CITY/STATE/ZIP: ? �C I PARCEL NUMBER: OWNER: fl?A n1/2,/`L‘2:-E a eC, PHONE NUMBER: MAILING ADDRESS: PLI- /Bowe (Street) (City/State) r(Zip) CONTRACTOR:L-e . le!( UrnC0 G LICENSE NUMBER: cL U (d�6 IJ P PHONE NUMBER:(9Oc) 17Z "3 MAILING ADDRESS: (PLI,Qel `fl. BOOLE- LC CDsrLtr Cil al WE -I.1) irfzO11/q (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT TOILETS I x 6.00 = &.00 SINKS ;.:.>;.: x 6.00 = &- Or SHOWERS x 6.00 = » . .:..::-'. ;:.,;BATH UBS I x 6.00 = C 0 KITCHEN SINKS x 6.00 = >= =a x 6.00 GARBAGE DISPOSAL x 6.00 = OPM:ggiCIMMISIIIIIIIIIIIIIIIPEOCI6.00 UTILITY SINKS x 6.00 = x .00 _ 6 .-�;;ci}_vr<>r::f i:�.;;. ..:.,:.x`:::::ic%:;:c-'::1<:::::•a::::ra- l` FLOOR DRAINS w x 6.00 = :<- ,::,n-i x 6.00 = BAR SINKS x 6.00 = .i.'f,.ti?•i:::._ii^:•3•Y':jjtiivn::..i"i�: ..ice.: _ _s?_4:i:?}ti:ity?:Kiri;%{'ivi!!-`.ii'i?i:?: -:[%1,.4.v{ilii}?ii:'-ii::i::i:i}-_:::_:'?'.'�--:nv: f.?�:f.:v'if�v}•x vi_.�? >.Li:v::_�ivvi.!-v:Jii:Y::3^:}i~:.iY-'rih:::M:i }:_4f i:,iACi;t:.-fi-C n- = :_Eq0 31=-gN§1 :... :;IgA- :`';<•:::M-111�i. x 6.00 •:::c:ia:-:ii:::as:;::c:-::-ilii_..�iK::ri'ctai:••+`i:= 'v��r3S-Si .:c- -.,rMrax<ti�:i�:tilax_xa`..x-i�eecit',�:.azfft•- LAWN SPRINKLER—FOR EACH BACKFLOW DEVICE x 6.00 = .::a!yi;:.?:i'.:..?rs::^-_""".,,.r?H.w,w,. .x.{i•::,•t:..:ai»:;?i;;_�s�:c. -ra.•?::.;..::srMimm.,....a::..: "�:{ <?:.;:S:t'f��•:;f::i::.•-::-i<<;:::-:<::S< a f:>::i:;✓:,`.:'.T59.-:-:??vrs+�v};::.-.:. = EWA�E�I #E�t>f�("I;=i,::;k::,:::>:: : :>;::>;:<:>;<�-,� :�::;_=>:«: :::>,>: � •€� I x6.00 -00 WATER SOFTENER x 6.00 = ;::.;:.>:,..:r::?.:;::.::::.:,i::.::,<.:y:.:::x:;.ii:.i:;.i:.>::.::.i:.::.i::-iii:.;;:: :f r:;>;>.;:.:.>;< .»::«::?<:::::;;::>:::: ;=_;::_-:.: ::::Caw: x 6.00 DRINKING FOUNTAIN x 6.00 = SUBTOTAL $ 0.CO PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS:TOTAL PERMIT FEE DUE =$ x,66 SIGNATURe177727,,,c-% Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675