2006, 06-13 Permit App: 06002297 Piping. ' Valley
Spokane
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)656-0036 FAX: (509)658-0037
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Plumbing Permit Application
❑ Commercial
PERMIT NUMBER: za�7
PERMIT FEE: tti
Residential
SITE ADDRESS:
Buldingowuer
DESCRIPTION OF WORK
# OF UNITS
X
Namr
=
TOTAL AMOUNT
Phone:
Fax:
Address: ,
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OA>
$6.03
City. Stair:
Zip:
2
URINALS
X
$6.00
Name:
e/Oi7 &
di 7
TUBS
Phone: (%a l9' c-7(, %
Fa,
Address:
L -r
// d/`/ -
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Jely
city: State:
Zip:
License No:
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b
City Business license No:
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
Name:
6
DISHWASHER
Phone:..
AUTHORIZED SIGNATURE:
REVISED 5/26105
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET BIDETS
X
$6.03
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
86.00
=
5
SINKS
LAVSBASINS, 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
=
B
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
86.00
=
13
FOUNTAINS, DRINKING
x
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
4 •
(4 •6
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
$8.00
=
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
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
86.00
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
815.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card#
SUBTOTAL
0 VISA ❑ MASTERCARD
PROCESSING FEE
$34.00
7 U
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 5/26105