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2004, 03-23 Permit App: BLD 04-03853 PlumbingPLUMBING PERMIT APPLICATION Sclre�� City of Spokane Valley Community Development Department BuildingDivision iley 11707 E. Sprague. Avenue, Suite 106 Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax: (509) 688-0037 FOR INSPECTIONS, CALL (509) 688-0054 Project Address: !� o y '5 G�4;i- Permit Use: Owner: �a-z7��.L�C 5�3' Phone (Daytime Contact): Mailing Address: / / 02",c viz 1-2 city State Zip Code Contractor: /lt-o-,z5` License #: �vZ60 Phone #: Mailing Address: f>Z/ BANKCARD NUMB AUTHORIZED SIGNATURE: Zip Code DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6.00 = 2 URINALS X $6.00 = 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 1 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 INSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 = 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 $6.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 = 19 F20 MEDICAL GAS r outlet NITROUS, OXYGEN X $6.00 = MISCELLANEOUS PLUMBING FIXTURE I X $6.00 = METHOD OF PAYMENT: ❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD DATE: EXPIRES: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: BANKCARD NUMB AUTHORIZED SIGNATURE: Zip Code