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16380 SW KING CHARLES AVENUE r+, Kit q City .. SW King Charles ' 10 1 f\� I3 1, F � 1 fi i 7 -7Q i n CITY OF T1r,ARD PlunnUng Pff'0'fIt 3 1 7 R Buliding Departmomt NO. _ Resiuential Z Commercial [� New In,taliaticn r] Replace Addition ❑ Alteration Dote L,ta Licensed " Plumber U4 P,�'tt,� � - _— — ---- - Owner akd 64 5 't Wti Ad�'ress Job Address Phone Applicant .�:�. ._ CITN HUSNESS LrENSE REQUIRED FOR ALL CONTRACTORS AND SUB-CONTRAC IFORS -------ITEM ' - i 4e. FEE TOTAL -- — ITEM �NO. FEE l TOTAL Fixtures 1 capes -- - 7'50 Sewer First 100 ft _-- 30 00 — iw Dishwasher - - T 7.50 _-- Each Addit.100 ft. - e 15.00 - Garbage Disposal - 7.50 - _- Ejector Pump Water Heater -_- 7.50 -� - - Water:First 100 ft. _ 20.01 r __- Backflow Preventer 7.50 Each Addit.200 f? _- - 15.00 --� -- �- - -- - - -- Storm&Rain Drain:First 100 ft. - -_ 30.00 -� JI- Each Addit.200 ft. - - _15.00 _ Mobile Home Space _ 25.00 --� Other(Spedy): --_ Rain Drain-Single Fa. Dw ing Comn , .is: �- -- -- PERMIT FEE - - - - --- - ----- _.- - --- ,TATE f�. aj Issued By _-;-- - a " Receipt No. 11-567 Applicai,, TOTAL -.''� ft� Signatu For Plumbing Inspection Phone 639-4171