1989, 08-10 Permit App: 89002748 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
Ii`iormation Worksheet
JOB STREET ADDRESS: 1` ;C j c/ Se. 2.O
CITY/STATE/ZIP: ,,,,ti, /Al PARCEL NUMBER:
OWNER: s w�
e -G2 y Lel SS 6u) PHONE NUMBER: 4//�
. (o /
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: f „ , , '.a j LICENSE NUMBER: Aran mA, /070 a G
PHONE NUMBER: 917 7 -0/(-?3
MAILING ADDRESS: Al `p,qV A /fai.rnT?)d gA Q. � X9267
(Street) ¶City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS f x $6. 00 =
SINKS x 6.00 =
SHOWERS / x 6. 00 =
BATH TUBS / x 6. 00 =
KITCHEN SINKS / x 6.00 =
DISH WASHERS x 6. 00 =
GARBAGE DISPOSAL x 6. 00 =
CLOTHES WASHER x 6.00 =
UTILITY SINKS I 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 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25. 00
1
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE 1 = $
� I I
SIGNATURE
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675