1992, 05-07 Permit App: 92003199 Plumbing Reversal PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS: E 14-! 0
CITY/STATE/ZIP: \€. j l . PARCEL NUMBER:
OWNER:lat.(3Qf2T L oFt=EIQ15E2GUL PHONE NUMBER:(509 ) y-4003
MAILING ADDRESS: E 141 3 -lT V @-2.A,cA.12 U,3(4 99.o3-7
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
TOILETS x 6.00 =
x 6.00 =
....... ..: .
SHOWERS x 6.00 =
x 6.00 =
KITCHENSINKS :;.;:.......................................................................................... i x 6.00 =
x 6.00 =
GARBAGEDISPOSAL.;:.;;:.;:............................................................................ x 6.00 =
CLOTHES WASHER ::>;: , > x 6.00 =
UTILITY SINKS x 6.00 =
x 6.00 =
FLOOR DRAINS:::::::.:.:..................................................................................... x 6.00 =
...........................................................................................
x 6.00 =
BAR SINKS x 6.00 =
x 6.00 =
ROQF D ,iNS :.
LAWN SPRINKLER- FOR EACH BACKFLOW DEVICE x 6.00 =
x 6.00 =
WATER SOFTENER:::::::.................................................................................. x 6.00 =
.................................................................................
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