2005, 08-12 Permit App: 05002917 Plumbing FixturesPLUMBING PERMIT APPLICATION
Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) f88,-oo37 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: f ' /f:3o'/ cce
Owner. eve (/w.k_ (//w •e fldev
Mailing Address:
Contractor.
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K (/
7660 F /cc /%ey cv c p
State
Mailing Address'
14- ///-r each' �w
Permit Use: p /u rrr 4,5
Phone/ (Daytime Contact): rot 72 / 5 7/4
veA'-L.0/C ova 9'r/o37
State . Zip Code
Phone #: SG9' 'Z/ 5 7/Z-
`/q0f7
Zip Code
City
License #:
City
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTOR OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
- - .
X
56.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
=
5
SINKS
IAVSBASINS, BAR, FLOOR KITCHEN.
LAUNDRY. UTILITY, JANITOR. PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
56.00
=
8
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
/
X
56.00
=
8
• 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
_
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING. REVERSAL
NSTALLATON, ALTERATION, REPAIR,
• REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
' -
ICE AN/OR COFFEE MAKER HOSE BIB,
STEAMER
PROCTER, CARBONATOR SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP. .
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE -
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
-
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: