2007, 06-18 Permit App: 07002326 PipingPermit Center
San u �. 11703 E Sprague Ave, Suite B-3
fa lie .\ Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
a/Y •s`,�Ri, ley wwtiv spokanevalley.nr�
Community Development
Plumbing Permit Application
PERMIT NUMBER:
I
PERMIT FEE:
❑ Commercial ,k- :Residential
SITE ADDRESS: (0 OSS N —&s.(
Building Owner _
Name: Imo, _ S,;-c\.7��. +. Phone: Fax:
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City: State: Zip. Q�.?�h
Address: ti a !J l7LS II
Contractor
Name Phone: Z Z _� Fax:
ti S 4 i
psT_miniOCAien.1,
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Address:' 0 ill to e"ILI S City: G'� -, State: i/✓1 — Zip: `j io hep
License No: - City Business Lic:
Contact
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Name:ThV•
A i NL Phone: "1 2.4 - V./LS--
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
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
1
X
$6.00
=
/ /�
is
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
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 0 CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
rrJJ i
_1
AUTHORIZED SIGNATURE:/Ucr'�t l
REVISED 8/26/05
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