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