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1991, 05-02 Permit App: 91002263 Plumbing FixturesPLUMBING PERMIT APF',_ICATION FORM Information Worksheet JOB STREET ADDRESS: CITY/STATE/ZIP: PARCEL NUMBER: OWNER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) CONTRACTOR: LICENSE NUMBER: PHONE NUMBER: MAILING ADDRESS: (Street) (City/State) (Zip) PLUMBING WORKSHEET/FEE SCHEDULE DESCRIPTION TOILETS SINKS °> SHOWERS :eATH TUBS KITCHEN SINKS DISHWASHERS GARBAGE DISPOSAL _:CLOTHES WASHER UTILITY SINKS ELECTRIC WATER HEATERS FLOOR DRAINS FLOOR SINKS BAR SINKS :ROOF DRAINS LAWN SPRINKLER SEWAGE EJECTOR WATER SOFTENER URINAL DRINKING FOUNTAIN NOTE: MINIMUM PERMIT FEE IS $35.00 SIGNATURE NUMBER OF UNITS X EACH UNIT = AMOUNT x6.00 = x 6.00 = x 6.00 = x6.00 = x6.00 = x6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = x 6.00 -=- x6.00 = x 6.00 x 6.00 = x6.00 = x 6.00 = x6.00 = x 6.00 = x 6.00 = x 6.00 = ag -. 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