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2008, 03-28 Permit App: 08001095 Plumbing
Permit Center �m.rRe 11703 E Sprague Ave, Suite B -3 ..0Valley Spokane Valley, WA 99206 (509)688 -0036 FAX: (509)688 -0037 Community Development www.spokancvallev.or<_ Plumbing Permit Application I Commercial PERMIT NUMBER: PERMIT FEE: Residential SITE ADDRESS: /4j,J / 3 , /20 it 400_2 Building Owner Name: - R-4-4, A�o,f9o. ..t ,mac . Phone: 7 Fax: ^� d Q.3...._ Y a - /' .7 L Address: cv 1� 9.5:14, # J /S io =, City: a.�i «re State: 4/./4,. Zip: Jt c,cZ/eres Contractor A . io Name: 7-.A> ��► ti % ®, �ii t�.�S% 5.-,..k f ` / /� Phone: C�7r - 5-4, es t,,, �' Address: �{%% es _e) p %tf.".e,� /el State: City: .S�fl /0o•, C. iit/ /� p: �1re�," .), License No: AL? City Business s Lic: L ®6 C, 9 �C► ? d Contact Name: L WO 9 S Phone: 99 -s-p6 (l DE?i'i;RIPTION OF WORK 1 TOILETS 2 URINALS 3 TUBS 4 SHOWERS PER TRAP SINKS # OF UNITS WATER CLOSET, BIDETS COST X $6.00 X $6.00 X $6.00 $6.00 BATH, STALL, ON -SITE BUILT LAYS /BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X -RAY, FOOD, PREP /CULINARY MEAT II $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 $6.00 II $6.00 DISHWASHER CLOTHES WASHER GARBAGE DISPOSAL WATER SOFTENER ELECTRIC WATER HEATER FLOOR DRAINS NOTE: IF GAS, SEE MECHANICAL AREA, CASE, COIL, TRENCH, CONDENSATE ROOF DRAINS /OVERFLOW DRAINS FOUNTAINS, DRINKING WATER PIPING /DRAIN -IN WASTE, VENT, PLUMBING, REVERSAL SEWAGE EJECTOR NSTALLATION, ALTERATION, REPAIR, REVERSALS WATER USING DEVICE GRINDER, SUMP PUMP ICE AN /OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER 17 CROSS CONNECTION DEVICE 18 INTERCEPTORS 19 MEDICAL GAS (per outlet) 20 MISCELLANEOUS PLUMBING FIXTURE 21 PRIVATE SEWAGE DISPOSAUSYS 22 INDUSTRIAL WASTE INTERCEPTOR METHOD OF PAYMENT: ❑CASH ❑ CHECK ❑ VISA ❑ MC Card# VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK NITROUS, OXYGEN EXPIRES: VIN: TOTAL AMOUNT O Sd- $6.00 $6.00 X $6.00 X $6.00 X $20.00 /8e X $15.00 SUBTOTAL PROCESSING FEE TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05 'J �/ $35.00