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1989, 07-10 Permit App: 89002142 Sewer PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: 2. (< ;//C) j/, CITY/STATE/ZIP• ,�� 97(.2V).6 PARCEL NUMBER: OWNER PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: _, , � ,'LICENSE NUMBER:,, `7 c27 �C C PHONE NUMBER: i7�' / MAILING ADDRESS: (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER OF X EACH DESCRIPTION FIXTURES FIXTURE = AMOUNT TOILETS x $6. 00 = SINKS x 6. 00 = SHOWERS 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 = SEWAGER x 6. 00 = WATER SOFTENER x 6. 00 = URINAL x 6. 00 = DRINKING FOUNTAIN x 6. 00 = SUBTOTAL $ C,� PLUS: PROCESSING FEE + $ 25. 00 I EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE 73 /�� S I GNATUR West 1303kBroadway Avty enue Spokane,WAS 99260 Safety 09 456-3675