1992, 06-01 Permit App: 92003851 Plumbing Reversal PLUMBING PERMIT APPCATION FORM a � 3 SSI
L'f
�/ Information orksheet .° l
JOB STREET ADDRESS: /3/ 0 • �' �'�
CITY/STATE/ZIP: nnSPR 1 nFJe 99 2! C, PARCEL NUMBER:
OWNER: f k . '�1 ,n 29 (;)e ,7, PHONE NUMBER: CEJ- 9 4-c 37
MAILING ADDRESS: C 1342,0 sto, 9 cj2 I (f,
(Street) (City/State) (Zip)
CONTRACTOR: ( U- IO'-QJ'{ LICENSE NUMBER:
PHONE NU .":BER:
MAILING ADDRESS: )
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
TOILETS x 6.00 =
SINKS... x 6.00 =
SHOWERS x 6.00 =
BATH TUBS x 6.00 =
KITCHEN SINKS x 6.00 =
DISHWASHERS x 6.00 =
GARBAGE DISPOSAL x 6.00 =
CLOTHES WASHER 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 =
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 =
/,�I i
�J a )0 'Ake��'��Y�-�� ,iB�, SUBTOTAL S
/" PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE I' $35.00 EQUALS: TOTAL PERMIT
FEE DUE =$3- '
ILSIGNATURE lJ
r 5/ II)7
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675