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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