2004, 08-03 Permit App: BLD-04-07219 Plumbing Fixtures, ReversalSaw
zo• 4' Permit Use:
Project Address: /
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Owner: qt_K 7ctt .s/q
Mailing Ad ress: g44 -L
Phone (Daytime Contact):
City State Zip Code
Contractor:(IL) p7,- 4.4 'pa e e 57-1..17;72-4.ticense #:10. tec /27,0 Phone #: cor ?„2 sv7S-
Mailing Address: / ??/ 5
ee.‘1..,/qc 1st S CI 409 ?2C)/,_2
State Zip Code
City
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
*OF
UNITS
X
COST
mg
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
LI : 0°
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
6 . 190
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6, c0
8
DISHWASHER
X
$6.00
.
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
56.00
=
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
S6.00
=
13
FOUNTAINS, DRINKING
X
$6,00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=
/
Le :
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
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
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56,00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
WOO
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
6
e:c— 9.•.P C.)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: