2007, 05-09 Permit App: 07001682 Plumbing Fixtures, ReversalPermit Center
Sp0"kane 11707 E Sprague Ave, Suite 106
$ Valley Spokane Valley, WA 99206
® (509)688-0036 FAX: (509)688-0037
Community Development ww,,•.spokanevallev.ore
Plumbing Permit Application n Commercial ,Residential
PERMIT NUMBER: /
yl
PERMIT FEE:
SITE ADDRESS: /3c en 7
At "-e
Buil ding Oivner %%
Name: / Phone: Fax:
n� ,.^
Address ! rj' m a [ L^ pr to t.< 71./‹.... try .0.91 ' e State: Le� q, Zip:q.q
( ! / ��e
Contractor '.. ... ..: _ '..,
_. ( ...
Name:`' Phone: Fax:
t tom,... c----:, L.,- e �,:t �
Address: �� ®� AY E es City: � / State: �� Zip: qe,. �/
?poor'
�f
License No / c p ` / �1 City Business Uc 7
c 07
;cialitiel-7: 111
Name: Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS -
X
$6.0D
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
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 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
=
6c m G
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
56.00
16
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
DCASH ❑ CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
/6477 i CPU'
AUTHORIZED SIGNATURE:
REVISED 8/26/05
D Do%R