2006, 02-28 Permit App: 06000618 Plumbing Fixtures, ReversalPermit Center
.sYoicane 11707 E Sprague Ave, Suite 106
Valley Spokane Valley, WA 99206
(509)68S-0036 FAX: (509)688-0037
Community Development '. ww.snokanevallev.ore.com
Plumbing Permit Application
PERMIT NUMBER: (1%/
PERMIT FEE:
❑ Commercial ❑ Residential
SITE ADDRESS: / l L7D tiP 6 OU vt
Building owner
Di'. Be, t y p f a ,..,ti
# OF UNITS
X
Name:
=
Phone:
Fax:
TOILETS
Address:
/
X
City. State:
=
Zip:
Contractor .
/jJLGihd.
4) LA.) i---- C
I
c-tc9eS. '.` •.-.=:
X
$6.00
Name:
CG , CO
3
Phone: .9 ,/-5 (s' y
Fax:
Address:
$6.00
=
City : State:
4
Zip:
License No:
/
X
City Business License No:
=
//
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Contact: s<. •. °
.: :.::
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
Name:
6
Phone:
AUTHORIZED SIGNATURE:
17/140
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
44‹; GO
2
URINALS
/
X
$6.00
=
CG , CO
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6.00
=
//
tP
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
J
X
$6.00
=
,UU
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
X
$6.00
=
4,r 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
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
36.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH JZ9 CHECK
Card#1
SUBTOTAL
�f
02 ,.,/, 0
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
,-f, OV
AUTHORIZED SIGNATURE:
17/140
REVISED 8/26/05