2004, 09-27 Permit Application: BLD-04-07765 Water PipingS
4,00/Valley
q./d 4.
Project Address:
Owner: , 5i -{)--r /Lv A(106 J
Mailing Address: 9e /" . D
Contractor: L j(li p
Mailing Address: ,3 qi rk 3 pa/14 Alp
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688 - 0036; Fax: (509) 688 -0037
FOR INSPECTIONS, CALL (509) 688 -0054
Permit Use:
Phone (Daytime Contact): Fa /-541
/
�({ . f)t hAiltt License
City
#: (
to /9- 97 9h13
State Zip Code
Phone #: qc /-5-7/ 5
if) t State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF -
UNITS
X
COST
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
S6.00
=
5
SINKS
LAVS /BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X -RAY, FOOD,
PREP /CULINARY/MEAT
X
$6.00
X
$6.00
6
DISHWASHER
7
CLOTHES WASHER
X
$6.00 }
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
_ X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
X
$6.00
=
12
ROOF DRAINS /OVERFLOW DRAINS
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
;r,
X
$6.00
=
f
.1� GJ(..)
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
16
' WATER USING DEVICE
ICE AN /OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6.00
=
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D_ FOR
VATS, TANKS, BOILERS
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FtXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK D VISA 0 MASTERCARD
rTATF. EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
j
; ` / L' 7 /. (J
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code