2006, 12-21 Permit App: 06004932 SewerSpokan''� e`"``
,,,valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevallev.oriz
Plumbing Permit Application
SITE ADDRESS:
❑ Commercial
PERMIT NUMBER:
PERMIT FEE:
esidential
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Building Owner �b/2.4, %i //6„.") 2
S- S Q/
Name:
Phone:
Fax:
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Address: X�) )
City:
State:
Zip:
Contractor \ _ CO tiirc `
Name: D\,/(^/ (142.‘ ra,t.
Cn.4AS
Phone:
Fax:
Address:
City:
State:
Zip:
License No��)U R. CC J6, /A. '7
City Business Lic:
Contact
Name:
Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
2
3
4
5
TOILETS
WATER CLOSET, BIDETS
X
$6.00
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
7
8
9
10
11
12
13
14
15
16
DISHWASHER
X
$6.00
CLOTHES WASHER
X
$6.00
GARBAGE DISPOSAL
WATER SOFTENER
X
$6.00
X
$6.00
ELECTRIC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
X
$6.00
X
$6.00
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
l
X
$6.00
GRINDER, SUMP PUMP
X
$6.00
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
$6.00
17
18
19
20
21
22
CROSS CONNECTION DEVICE
INTERCEPTORS
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS,
BOILERS
X
$6.00
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING FIXTURE
PRIVATE SEWAGE DISPOSAL/SYS
X
$6.00
x
$20.00
INDUSTRIAL WASTE INTERCEPTOR
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
X
$15.00
SUBTOTAL
PROCESSING FEE
TOTAL P ' MIT FEE DUE:
$35.06
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