2008, 07-22 Permit Application: 08002832 Cross Connectiont�r r"�i
Spokane _`
.00.0 Valley
Community Development
Plumbing Permit Application n Commercial
Permit Center
11703 E Sprague Ave, Suite B -3
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
perrnitcenter@spokanevalley.org
PERMIT NUMBER: y',3 3 Z
PERMIT FEE:
❑ Residential
41-
SITE ADDRESS: cam/ / 7 E �
Building Owner GX /` dia Z /vQ U e f
Name: Phone: ( -09 a
ax:
Address: gy/ 7 •' ti�I City: LO �il--"Q
State: 1,‘,1
Zip: 7 /
Contractor
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact
Name:
Phone:
DESCRIPTION OF WORK
1
TOILETS
WATER CLOSET, BIDETS
# OF UNITS
X
COST
TOTAL AMOUNT
X
$6.00
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
5
6
SHOWERS PER TRAP
SINKS
DISHWASHER
BATH,
STALL, ON -SITE BUILT
LAVS /BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
X
X
$6.00
$6.00
$6.00
1
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
$6.00
10
ELECTRIC WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
12
ROOF DRAINS /OVERFLOW DRAINS
X
$6.00
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
16
WATER USING DEVICE
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
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
r
X
X
$6.00
$6.00
$6.00
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: