1992, 01-29 Permit App: 92000512 Water Heater Q.L1U•N PLUMBING PERMIT APPLICATION FORM 53
Information Worksheet
JOB STREET ADDRESS: //?' G /'7"✓R-- r-A/
CITY/STATE/ZIP: 4nku - WA- PARCEL NUMBER:
OWNER: I,4/A)J'e+tc.2 A te f5d PHONE NUMBER: y'4211 5p /
MAILING ADDRESS: r'��--
(Street) (City/State) (Zip)
CONTRACTOR: Tz 01 fl s 1" 1,4 4 LICENSE NUMBER: TZ rpt.E pl 107 6
PHONE NUMBER: '5-3 S 15'1/
MAILING ADDRESS: 910'4 er4 SpD •c CO/4V
99z�v
(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 1 x 6.00 = (rj
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 =
SUBTOTAL $ (9. 0
PLUS: PROCESSING FEE + $ 25.00
1
EQUALS: TOTAL PERMIT -
NOTE: MINIMUM PERMIT, E IS •3 5.0 0 FEE DUE 1= $ S S O o
SIGNATURE C
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675