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1990, 02-12 Permit App: 90000505 Water Softener PLUMBING PERMIT APPLICATION FORM Information Worksheet -(4 JOB STREET ADDRES :___4F, 7/a')'` /7 CITY/STATE/ZIP: /. >J�C)h . 98144- PARCEL NUMBER: OWNER: 'iii,lb.p,.,, ,g [.,911410_},.._J PHONE NUMBER- ‘o/ -,41/1-7 MAILING ADDRESS: r. 7/i // ã22 .94 (Street) (City/State) (Zip) CONTRACTOR: -C,.kt-a-) I / _% • LICENSE NUMBER: Si-i4e, . s e _.37', A/ _ PHONE NU MB R: ,3W- 549-//7) X.iii MAILING ADDRESS: .-/ 0 ,Z J77 7 �c) /� 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 =1 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 SUBTOTAL $ e-9 PLUS: PROCESSING FEE + $ 25. 00 1 EQUALS: TOTAL PERMIT NOTE: MINIMUPERMIT/FEE IS $35.00 FEE DUE 1 = $ --- O � I SIGNATURE _12, ,e__( _ _ Spokane County Department of Building, and Safety West 1303 Broadway Avenue Spokane, WA 9260 (509) 456-3675