1989, 05-08 Permit App: 89001209 Sewage Injector PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: j ,q ) c C. . 7/
CITY/STATE/ZIP: rCa �l 9 9 a//e PARCEL NUMBER: V., 5",9
OWNER: _u PHONE NUMBER: 5.7Sq - 9 /,- 4 3
MAILING ADDRESS: /a 9 I q P4. / ) _ (Lipt 9 9 ? !
(Street) (City/State) (Zip)
CONTRACTOR:?‘10/ ( 4 uJ ( LICENSE NUMBER:/ -er-CoW --1,231(F.
PHONE
/.z3J(F-
PHONE NUMBER: Q2 G, -$'9 G Li
MAILING ADDRESS: ewe/7 7 (, , gga0 4,
(Street) a (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF X EACH
DESCRIPTION FIXTURES FIXTURE = AMOUNT
TOILETS x $4.00 =
SINKS x 4.00 =
SHOWERS x 4.00 =
BATH TUBS x 4.00 =
KITCHEN SINKS x 4.00 =
DISH WASHERS x 4.00 =
GARBAGE DISPOSAL x 4.00 =
CLOTHES WASHER x 4.00 =
UTILITY SINKS x 4.00 =
ELECTRIC WATER HEATERS x 4.00 =
FLOOR DRAINS x 4.00 =
FLOOR SINKS x 4.00 =
BAR SINKS x 4.00 =
ROOF DRAINS x 4.00 =
LAWN SPRINKLER x 4.00 =
SEWAGE EJECTOR x 4.00 =
WATER SOFTENER x 4.00 =
URINAL x 4.00 =
DRINKING FOUNTAIN x 4.00 =
SUBTOTAL $
PLUS: PROCESSING FEE + $ 15. 00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $20.00 FEE DUE 1= $ ;)ei c
Signature
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Snokane_ WA QQ2Rn tcn41 Ac -2n7c