2005, 01-13 Permit App: 05000128 Plumbing FixturesProject Address:
Owner:
Mailing Address:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
v 0 9 5 • eouid i c7 / 121) Permit Use:
(Cr GCif) /4/)/CT
aX(c`, 5, eo. )3;Sit CO- sf/(/✓ l
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
C3' VA'
Phone (Daytime Contact):
City f State S Zip Code
Contractor: 6:-K(44/‘)R.5. License #: /%v 44�/06:%5.13hone #: 996( 5-6 5-`7
Mailing Address: ��p`i'7 5C- /2 /(;L) 07/k L(c) ,34/��
City State Zip Code
DATE / -
BANKCARD NUMBER:
EXPIRES
TOTAL PERMfT FEE DUE:
.0
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/UNITS
J
X
$6 00
=
47, 0 CJ
2
URINALS
X
$6 00
3
TUBS
X
$6 00
4
SHOWERS (PER TRAP)
BATH, STALL ONSITE BUILT
I
X
$6 00
6.6 0
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY. FOOD, PREP/CULINARY MEAT
X
S6 00
=
% d
�P
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
=
i
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6 00
r11
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6 00
13
FOUNTAINS, DRINKING
X
$6 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALtATION, ALTERATION. REPAIR.
REVERSALS
X
$6 00
=
` 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 RP BP 0 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
SUBTOTAL
DL -/.60
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.08
DATE / -
BANKCARD NUMBER:
EXPIRES
TOTAL PERMfT FEE DUE:
.0
AUTHORIZED SIGNATURE: