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2006, 09-08 Permit App: 06003578 Plumbing Fixtures�� Permit Center Sgokane 11707 E Sprague Ave, Suitc 106 cogoaaaValSpokane Valley, WA 99206 ley (509)688-0036 FAX: (509)688-0037 Community Development www spnkanevallev.or¢ Plumbing Permit Application ❑ Commercial [4Residential PERMIT NUMBER: Z5/78 PERMIT FEE: (p (e ,U SITE ADDRESS: /3 3 / Building Owner - .. ...• .. .. . . Name: �pt' 9inr5 Phone: Fax: �'77//�~ $'f3— o��.D Address: /+ � o /:t �,'SS. a�✓• City: yos4Na state: m, zip: 97,716 Addreactor ��E Nam=. Sa/V'A//.q &I' TT • v. ',.... ."' ' 12...1Fax: Address: sty if Am., sEatc:t Zip: 9so?7 license No:.SON S4G 97 /41Al City Business Lic: ZD 6'/v 74' ,( Name: arm" Phare: Zt g -- /t'og. DESCRIPTION OF WORK #OOF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS / X 56.00 = 2 URINALS X - 56.00 = 3 TUBS / X 56.00 = 4 SHOWERS (PER TRAP) BATH, STALL ONSITE BUILT .X 56.00 = 5 SINKS LAVSBASINS, BAR. FLOOR, KITCHEN, LAUNDRY. UTILITY, JANITOR PHOTO, 3 - X 56.00 = X-RAY, FOOD, RE /CULINARY MEAT 6 DISHWASHER / X 56.00 7 CLOTHES WASHER / X 56.00 = 6 GARBAGE DISPOSAL X 56.00 9 WATER SOFTENER X 56.00 = 10 - ELECTRIC HOT WATER TANK NOTE IF GAS, SEE MECHANICAL X . 56.00 = 11 FLOOR DRAINS AREA. CASE, COIL TRENCH, CONDENSATE X 56.00 = 12 ROOF DRAINS/OVERFLOW DRAINS a1 X 56.00 = 13 FOUNTAINS, DRINKING X 56.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING. REVERSAL NSTALLATION, ALTERATION, REPAIR REVERSALS 1 X 56.00 = 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 - 1 X 56.00 = 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 $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN - X 56.00 = 20 MISCELLANEOUS PLUMBING FIXTURE 1 X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X 515.00 = METHOD OF PAYMENT: OCASH 0 CHECK 0 VISA 0 MC Card# SUBTOTAL - EXPIRES: PROCESSING FEE $35.00 VIN: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED BR6N5 r OA- t/L:( \E3 coCo 1-2,3l5 E- Ocin 14.6 Qxi 1711 I' 1 3_ e d MUT -->J "4, nr.. and.' i.w N.m.nnwuem.ie.w Maur in.e�m ELM CORPORATION Thursday, Sep 07, 2006 03:45 PM J?v,hmOon Ma'am. 11:01 •