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2008, 03-04 Permit App: 08000698 Water HeaterPermit Center Sioliane 11703 E Sprague Ave, Suite B -3 400000 Valley Spokane Valley, WA 99206 (509)688 -0036 FAX: (509)688 -0037 Community Development www.spokanevalley.org Plumbing Permit Application (l Commercial SITE ADDRESS: PERMIT NUMBER: 0 (09 Cj PERMIT FEE: ❑ Residential LI I- Building Owner Name: /� of Phone: P>G� -6 7� Pj 7 Fax: Address: / �l tA c_ (Axh2.t.+ City: '� ��// State: () a Zip: / ./raj Contractor ( Name: P 6 / a4„,i, Fax: Address: it--37-7 State: Zip: License No: City Business Lic: Contact Name: Phone: DESCRIPTION OF WORK TOILETS 2 URINALS 3 TUBS # OF UNITS SHOWERS PER TRA SINKS WATER CLOSET, BIDETS BATH, STALL, ON -SITE BUILT COST X $6.00 X $6.00 X $6.00 TOTAL AMOUNT LAVS /BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X -RAY FOOD, PREP /CULINARY MEAT DISHWASHER CLOTHES WASHER GARBAGE DISPOSAL WATER SOFTENER $6.00 $6.00 ELECTRIC WATER HEATER FLOOR DRAINS NOTE: IF GAS, SEE MECHANICAL AREA, CASE, COIL, TRENCH, CONDENSATE $6.00 $6.00 $6.00 $6.00 $6.00 ROOF DRAINS /OVERFLOW DRAINS FOUNTAINS, DRINKING WATER PIPING /DRAIN -IN WASTE, VENT, PLUMBING, REVERSAL SEWAGE EJECTOR NSTALLATION, ALTERATION, REPAIR, REVERSALS $6.00 $6.00 $6.00 $6.00 GRINDER, SUMP PUMP $6.00 WATER USING DEVICE ICE AN /OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER 17 CROSS CONNECTION DEVICE 18 INTERCEPTORS 19 MEDICAL GAS (per outlet) VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK 20 MISCELLANEOUS PLUMBING FIXTURE 21 PRIVATE SEWAGE DISPOSAL/SYS 22 INDUSTRIAL WASTE INTERCEPTOR METHOD OF PAYMENT: ❑CASH ❑ CHECK ❑ VISA ❑ MC Card# AUTHORIZED SIGNA $6.00 NITROUS, OXYGEN EXPIRES: VIN: V $6.00 $6.00 X $6.00 X $6.00 X $20.00 X $15.00 SUBTOTAL PROCESSING FEE ©0 TOTAL PERMIT FEE DUE: Effective October 28, 2007 P: \Community Development\Forms\Building forms\Plumbing Permit Application.doc $35.00 f�J ®C3 %/.