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2007, 11-13 Permit App: 07004523 Sewer Ejector• Permit Center q5-23 S 11703 E Sprague Ave, Suite B-3 Valley Spokane Valley, WA 99206 PERMIT NUMBER: (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevalley.org PERMIT FEE: Plumbing Permit Application ❑ Commercial [Nesidential SITE ADDRESS: /Y 3 tP I / E� L),A Building Owner ( Name: G S(��� Phone: _ Fax: Address: ILI�JQ City: State: Zip: Contractor . . . Name: ��Z /� S`%l�yG Phone:Zc !!�. r}i Fax: O Address: ZZOS- City: S tGA�� State: Zip: 9 —"o License No: City Business Lic: Contact . Name:/� �jJq �U/V�p_ Phone: 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 PERTRAP 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 X $6.00 = 6 DISHWASHER X $6.00 7 CLOTHES WASHER X $6.00 = 8 GARBAGE DISPOSAL , X $6.06 = 9 WATER SOFTENER X $6.00 _ 10 ELECTRIC WATER HEATER NOTE: IF GAS, SEE MECHANICAL X $6.00 = 11 1 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 NSTALLATION, 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 MEDICAL GAS(per outlet NITROUS, OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X 1 $15.00 = METHOD OF PAYMENT: ❑CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES: Card# VIN: SUBTOTAL (_ w PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: /. 00 AUTHORIZED SIGNATURE: REVISED 8/26/05