1991, 06-20 Permit App: 91003478 Plumbing FixturesPLUMBING PERMIT APPLit'ATION FORM
Information Worksheet
JOB STREET ADDRESS: %..S— � .'x
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:_
MAILING ADDRESS: -�!�•
(Street)
CONTRACTOR:
MAILING ADDRESS:
(Street)
DESCRIPTION
(City/State)
(Zip)
LICENSE NUMBER:
PHONE NUMBER:
c,
(City/State)
PLUMBING WORKSHEET/FEE SCHEDULE
NOTE: MINIMUM PERMIT FEE IS $35.00
c�
SIGNATURE
(Zip)
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675