1989, 08-24 Permit App: 89002975 Plumbing Fixtures PLOMBIIG PERMIT APPLICATION FORM )60 ii
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Information Worksheet
JOB STREET ADDRESS: - /28o/ mRo
CITY/STATE/ZIP: , W4• q42/40 PARCEL NUMBER:
OWNER: m LX.b,/4Ze PHONE NUMBER: 9Z4/- 9cQ3
MAILING ADDRESS: 0 1/ME
(Street) (City/State) (Zip)
CONTRACTOR: J E ey Reg. LICENSE NUMBER: 4e40.. /L9
,ce-4 P /3rd Nd
PHONE NUMBER:
MAILING ADDRESS: 6-1,. J / //Z/ M/¢/Ai , 6..>A• 492/0
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS / x $6. 00 = (0.40
SINKS 2 x 6.00 = /Z-0°
SHOWERS / x 6.00 = (p-OO
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 = L/-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 =
I
SUBTOTAL $30,00
PLUS: PROCESSING FEE + $ 25. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $ '019
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1‘;-2g21/12L-----
SIGNATU
Spokane County Department of Buildinq and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675