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1992, 07-21 Permit App: 92005555 Plumbing Fixtures PLUMBING PERMIT APPLICATION FORM w Information Worksheet JOB STREET ADDRESS: E'451 /0764 • /417fI AVE CITY/STATE/ZIP: VG P,4OAte , M1`0 z :f 6 5 1 PARCEL NUMBER: OWNER: An/ FCA€t- LAP/ /14/1/1/1 /R PHONE NUMBER: 32)9--RP?-`9 7r'1 MAILING ADDRESS: /1/761/ - /L/9 .41 v 11E,RAt WA , 4105 (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 = x600 = SHOWERS x 6.00 = x6.00 = KITCHEN SINKS x 6.00 = x6.00 = GARBAGE DISPOSAL x 6.00 = CLOTHES WAN>mEt >: » x 6.00 = UTILITY SINKS x 6.00 = ELECTRIC WATER HEATERS x 6.00 = FLOOR DRAINS x 6.00 = x6 i� .00 = BAR SINKS x 6.00 = x600 = LAWN SPRINKLER - FOR EACH BACKFLOW DEVICE x 6.00 = x6 .00 = WATER SOFTENER x 6.00 = x 6.00 = DRINKING FOUNTAIN x 6.00 = SUBTOTAL $ °r 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