2008, 05-09 Permit App: 08001712 PlumbingLpo ane
Il`y
Community Development
Plumbing permit
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
www.spokanevalley_.ore.com
Application ❑ Commereiall iR egikell i
SITE ADDRESS 1 K l i, S, 4 I IL;
PERMIT NUMBER:
PERMIT FEE:
Building owner
Name: l]iQylnO✓L� fJ� i� –t7L� /.snS f
Address: Z(&2 N• � t, � � l" , / ,��i
Contractor
Name: n/I 17 56
Address:
License No:
Contact
Phone:_ q 6 (- Fax 926 -'a `14-/
c;tyS y��,�,,''
,1raftfL State f,�J
/� 2;1 _1 s!
Fax:
City State��..�` =a
Zip
J i ✓l C7
Phone:
City Business License No:
Name: act 1
1
Phone: 21 — / z e
DESCRIPTION OF WORK
TOILETS
WATER CLOSET, BIDETS
# OF UNITS
2
3
4
URINALS
TUBS
SHOWERS (PER TRAP)
5
SINKS
BATH, STALL, ON -SITE BUILT
LAYS /BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
Z
Z
X
X
X
X
X
COST
X
$6.00
$6.00
$6.00
$6.00
$6.00
TOTAL AMOUNT
12
6
7
DISHWASHER
CLOTHES WASHER
8
9
10
11
12
13
14
GARBAGE DISPOSAL
WATER SOFTENER
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS /OVERFLOW
DRAINS
FOUNTAINS, DRINKING
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
15
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
16
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
19
20
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING
FIXTURE
GRINDER, SUMP PUMP
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
21
22
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
INTERCEPTOR
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
DATE:
AUTHORIZED SIGNATURE:
❑ VISA ❑ MASTERCARD
EXPIRES:
2
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$20.00
$15.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
i0
lZ
/ 73
$35.00
REVISED 8/26/05