2009, 06-25 Permit Application: 09001884 DWVPermit Center
�� of 11703 E Sprague Ave, Suite B -3
Spokane Valley, WA 99206
.40"."*Valley. (509)688 0036 FAX: (509)688 -0037
www.sp0kanevalley.org
Community Development
Plumbing Permit Application
SITE ADDRESS:
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PERMIT NUMBER: r/n%
PERMIT FEE:
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1 Residential
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Building Owner /-
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Name:
Phone: ?r--- ? .3
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Fax:
Address: s l 5%
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Contractor
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Name: TLC CONSTRUCTION
Phone: 509 -456 -3687
Fax:
Address: 9006 S. HAYFORD RD.
City: CHENEY
State: WA
Zip: 99006
License No: TLCCO * *107M6
City Business Lic: 601263777
Contact
Name: TERRY COURCHAINE
Phone: 509 -456 -3687
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1
2
DESCRIPTION OF WORK
TOILETS
# OF UNITS
X
COST
TOTAL AMOUNT
WATER CLOSET, BIDETS
X
$6.00
URINALS
3 TUBS
X
X
$6.00
$6.00
4 SHOWERS (PER TRAP)
5
SINKS
BATH, STALL, ON -SITE BUILT
$6.00
LAVS /BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
X
$6.00
6
7
DISHWASHER
X
$6.00
CLOTHES WASHER
X
$6.00
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10
11
12
13
14
15
16
ELECTRIC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
X
$6.00
X
$6.00
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
ROOF DRAINS /OVERFLOW DRAINS
FOUNTAINS, DRINKING
X
$6.00
X
$6.00
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
d
X
$6.00
GRINDER, SUMP PUMP
X
$6.00
WATER USING DEVICE
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
$6.00
17
CROSS CONNECTION DEVICE
18 INTERCEPTORS
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS,
BOILERS
$6.00
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19 MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20 MISCELLANEOUS PLUMBING FIXTURE
21 PRIVATE SEWAGE DISPOSAUSYS
X
$6.00
X
$20.00
22 INDUSTRIAL WASTE INTERCEPTOR
METHOD OF PAYMENT:
X
$15.00
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05