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1992, 02-20 Permit App: 92000910 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM6-O‘ � 2 `�/.' Information Worksheet r JOB STREET ADDRESS: g 6 4.5)7 7TN 1J 1 CITY/STATE/ZIP: SPOk�k_ k)4 f92.42- PARCEL NUMBER: -D--14 ` ) ��' 6 4_14s OWNER: L.R.4_- Ey%$lJv ) PHONE NUMBER: S'55- SSI 73 MAILING ADDRESS: f. . C'107 7 114 5i2olcoNts J (,,i I4- f z-1Z. (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER X EACH DESCRIPTION OF UNITS UNIT =AMOUNT TOILETS x 6.00 = SINKS;.::.:;. :;;; :.:.:............... i'i'l i::. x 6.00 = SHOWERS x 6.00 = ..ATH....USS ....... >::; >:>'`' :: '<> :::>::<: ..:.,.'< >::.:;: ::>::>:: x60 0 = .;;:......................:::::::.::::::::.::::::::::::::::::::::::::::::::::::::::::::::.............................. KITCHEN SINKS I x 6.00 = x 6.00 = DIS.H.:WASNERS>>::;>: ':': > `':.: >'`::;<::>: :':::: :::....:: ;;;:;:. .::: GARBAGE DISPOSAL x 6.00 = CLQTHES WASHER... :` ':.::::>`< : x 6.00 = UTILITY SINKS x 6.00 = ELECTRIC WATER HEATERS x 6.00 = FLOOR DRAINS x 6.00 = FLpOR SINKS x 6.00 = BAR SINKS x 6.00 = x 6.00 = LAWN SPRINKLER- FOR EACH BACKFLOW DEVICE x 6.00 = SEWAGE EJECT7R x 6.00 = WATER SOFTENER x 6.00 - x 6.00 = DRINKING FOUNTAIN x 6.00 = SUBTOTAL $ PLUS: PROCESSING FEE +$ 25.00 NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT FEE DUE . _$ SIGNATURE __ ___A ,4,2,6.,-- Spokane County Division of Buildings West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675