2008, 03-11 Permit App: 08000838 Plumbing Fixtures• it
Stioliane
.000 Valley
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Plumbing Permit Application (l Commercial
SITE ADDRESS:
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PERMIT NUMBER:
PERMIT FEE:
Residential
Building Owner �r , , _
Name: /� `
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Phone: `n7 - U �y7 L
Fax:
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Address: 7‘,7 (7?
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City. S',+C'C) /Cl¢/1Ji . /m,,State:
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Zip:
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Contractor
Name:
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Phone:
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Fax:
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Address: / O elf; 6 G /9% /L/
City:
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State:
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Zip:
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License No:st,s / c� ',Q 9'v It
City Business Lic:
Contact / fid P Y p
Name:
Phone: 9A 2 _ /s—
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
r
x
$6.00
fo • vo
2
3
4
5
URINALS
TUBS
X
$6.00
X
$6.00
SHOWERS (PER TRAP)
SINKS
BATH, STALL, ON-SITE BUILT
X
$6.00
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 WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
a e,,
12
13
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
X
$6.00
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
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
19
20
21
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA MC
Card#
AUTHORIZED SIGNATURE:
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
Effective October 28, 2007
P:\Community Development\Forms\Building forms\Plumbing Permit Application.doc