1993, 02-09 Permit App: 93000749 Plumbing Fixtures2
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS' F 68/7 9
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: GLEN OAgt3ir PHONE NUMBER: 924-5525
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: CNA PGni LICENSE NUMBER: Sat Afee C/09C3
PHONE NUMBER:
MAILING ADDRESS: N 732.0 Mani 4- isol07
(Zip)
(Street) (City/State)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
IIJIf'.,a.„,
SHOWERS
BATH TUSr.,"'.'�
KITCHEN SINKS
grfii AS
GARBAGE DISPOSAL
UTILITY SINKS
FLOOR DRAINS
Pag
BAR SINKS
0 c,
LAWN SPRINKLER — FOR EACH BACKFLOW DEVICE
WATER SOFTENER
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
k,0
NUMBER
OF UNITS
XEACH
UNIT
= AMOUNT
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
/
/
/
/
SUBTOTAL
$ 29 °'
PLUS: PROCESSING FEE
+ $ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
= $ 19 oo'
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675