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1990, 01-22 Permit App: 90000257 Furnace PLUMBING PERMIT-APPLICATION FORM Information Worksheet, JOB STREET ADDRESS: 3 7-/ £ /D CITY/STATE/ZIP: PARCEL NUMBER: ( 9V7 SZ/ r C)Sit7gr OWNER: () ; �� PHONE NUMBER: 9 �� -/d E 1 MAILING ADDRESS: 1 V 3 C (j 11' S A)9 (Street) (City/State) / (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: 75/Z) (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE NUMBER OF X EACH DESCRIPTION FIXTURES FIXTURE = AMOUNT TOILETS 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 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