2004, 08-02 Permit App: BLD-04-07201 Plumbing FixturesSfaane
4,Valley
Project Address: 110 /V - (iorTig-
Owner 11/1tCt-i'R'i.t Th4:14)
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact): 577 99D Sofa
Mailing Address: 5 Spn )/fro s 1414 9 9.0V%--
n State Zip Code
Contractor: ,TM c --S b& �f L6t 44Th/?M License #: Phone #:
Mailing Address:
City
City
State
BANKCARDNUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
2
URINALS
X
38.00
=
3
TUBS
X
36.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
36 00
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
.G.-_
X
36.00
=
6
DISHWASHER
X
38.00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
36.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
38.00
=
13
FOUNTAINS, DRINKING
X
$6 00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
38.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
38.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
38.00
=
.17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
38.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
38.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
38.00
=
METHOD OF PAYMENT:
VISA ❑ MASTERCARD
,CASH 0 CHECK )(VISA
DATE. O 8 0 ]-- 0 Ci iPP` EXPIRES:
SUBTOTAL
PROCESSING FEE
335.00
TOTAL PERMIT FEE DUE:
BANKCARDNUMBER:
AUTHORIZED SIGNATURE:
Zip Code