2013, 09-09 Permit App: BLD-2013-1796 Plumbing FixturesPermit Center
Spokane 11707 E Sprague Ave, Suite 106
Valley
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
Community Development www.spokanevalley.ore.com
Plumbing Permit Application ❑ Commercial
or Residential
;Nu m,.
SITE ADDRESS 17 3a s £ - P Id c-.' .
Bulldirig owner
5607 3, 3 2v2
Name: Of a✓*Aoll o Qp c&A,s, f"
Phone:
Fax
Address:
License No:
City
State
City Business License No:
Zip
Name: Pam,„‘
Phone: 'Z( — getZ�/
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
$6.00
=
1 g
2
URINALS
X
$6.00
=
3
TUBS
°°
3
x
$6.00
=
1 `0
4
SHOWERS (PER TRAP)
P
BATH, STALL, ON -SITE BUILT
X
$6.00
5
SINKS
r 0I E AVS /BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
I e-
I
X
$6.00
6
DISHWASHER F
X
X
$6.00
=
�p
7
CLOTHES WASHER �—
i .., 6 ../ t
(
$6.00
=
Co
8
GARBAGE DISPOSAL I
X
X
$6.00
$6.00
=
9
WATER SOFTENER II
CS'� �.p "�I I _ CENTER
10
ELECTRIC HOT WATER TANK Q
' ! " 'NOTE: IF GAS, SEE MEEFIA I
X
$6.00
=
11
FLOOR DRAINS
- AREA, CAS , COIL,-TRENCH, CONDENSATE ,I
j 1
X
$6.00
=
12
ROOF DRAINS /OVERFLOW =-
DRAINS
_ -_ i
_ I
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
$6.00
=
16
WATER USING DEVICE
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
Z
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
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
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
DATE:
SUBTOTAL
96'
❑ VISA ❑ MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05