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1989, 09-19 Permit App: 89003487 Sewer PLUMBING PERMIT APPLICATION FORM Information Worksheet JOB STREET ADDRESS: f'. CITY/STATE/ZIP: ) kc,______ PARCEL NUMBER: OWNER . -, ,,_ ��c PHONE NUMBER: 5 rr 2 c MAILING ADDRESS: o.57 /6/1 jha.A�JQ � _ , (Street) City/State) (Zip) CONTRACTOR: Ab. o . ,ICENSE NUMBER://6/4/1.// P ONE NUMBER: MAILING ADDRESS: 5 D� LL - 9?&o6 (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 = SEWAGE EJECTOR x 6. 00 = WATER SOFT NER x 6. 00 = Ge , x 6. 00 = �r DRINKING FOUNTAIN x 6. 00 = SUBTOTAL $ ' : PLUS: PROCESSING FEE + $ 25. 00 1 EQUALS: TOTAL PERMIT NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE I = $ SIGNATURE " West 1303kBroadway AvDepartment nue Sp kane, WAS 92260 Safety 09 456-3675