1992, 02-21 Permit App: 92000961 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: [ rp 5;6- /1 9`
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
treet) (City/State) (Zip)
CONTRACTOR: (2-4. 14.'s Pitt I �RQt . LICENSE NUMBER: l�� ,-S/0//--73
r
PHONE NUMBER:
MAILING ADDRESS: 19,o . 60( .5gi‘f Efo LDA •
(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 = (p •d
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 =
...........................................................................................................................................
(: » » >>> >> <»> >< > x =
BAR SINKS x 6.00 =
ROOF.DRAINS. x 6.00 =
............................................................................................................................................
LAWN SPRINKLER- FOR EACH BACKFLOW DEVICE x 6.00 =
SEWAGE EJECTOR x 6.00 =
WATER SOFTENER x 6.00 = { .(0
URINAL:.::....:.:.:.. ... . x 6.00 =
DRINKING FOUNTAIN x 6.00 =
SUBTOTAL $•
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675