1989, 05-16 Permit App: 89001305 Sewer •
PLUMBING PERMIT APPLICATION FORM
Information Worksheet Y/l/G
JOB STREET ADDRESS: T>. 4,0C li 2Q_Le--V
CITY/STATE/ZIP: SIP0l ^s 97.2)(, PARCEL NUMBER: 2151'2 -- f7.5(1
OWNER: 'v,J S T (-f PHONE NUMBER: q 2 k ¶> C (
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS: 5- /6)(2)(o (C;C L u qy
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS x $4.00 =
SINKS x 4.00 =
SHOWERS x 4.00 =
BATH TUBS x 4.00 =
KITCHEN SINKS x 4.00 =
DISH WASHERS x 4.00 =
GARBAGE DISPOSAL x 4.00 =
CLOTHES WASHER x 4.00 =
UTILITY SINKS x 4.00 =
ELECTRIC WATER HEATERS x 4.00 =
FLOOR DRAINS x 4.00 =
FLOOR SINKS x 4.00 =
BAR SINKS x 4. 00 =
ROOF DRAINS x 4.00 =
LAWN SPRINKLER x 4.00 =
SEWAGE EJECTOR x 4. 00 =
WATER SOFTENER x 4. 00 =
URINAL x 4.00 =
DRINKING FOUNTAIN x 4.00 =
SUBTOTAL $
NTet21 REPC-PocLwA.Er`►Y PLUS: PROCESSING FEE + $ 15. 00
I
EQUALS: TOTAL PERMIT)
NOTE: MINIMUM PERMIT FEE IS $20.00 FEE DUE <'0.00
_ � f
Signature
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Snokann_ WA acorn mum Acn_la-in