1991, 08-08 Permit App: 91004851 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: / T�=4tdE.-
CITY/STATE/ZIP: 5,D,e- -,- I PARCEL NUMBER:
OWNER: /)(4142/EL meati% PHONE NUMBER: '7c71-7--C -275----
MAILING
IS-7-rs7sMAILING ADDRESS: . 4z7, e9�
(Street) (City/State) (Zip)
CONTRACTOR: OCL Y `$ /7Ctl--9/3/4' LICENSE NUMBER: D yPi 271
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State)- (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
TOILETS x 6.00 =
x 6.00 =
SHOWERS x 6.00 =
BATH TUBS° x 6.00 =
KITCHEN SINKS 1 x 6.00 = 6.o d
DISH WASHER.... / x 6.00 = .69 U
GARBAGE DISPOSAL x 6.00 =
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 =
ROOK 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 $ /Z.aca
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS $35.00 EQUALS: TOTAL PERMIT
FEE DUE =$ 3 700
SIGNATURE C �•
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675