2008, 03-13 Permit App: 08000890 Cross Conn DevPermit Center
11703 E Sprague Ave, Suite B-3
Spanokane Spokane Valley, WA 99206
�%� (509)688-0036 FAX- (509)688-0037
•Cl��ey w �okancvalley.ore
Community Development
Plumbing Permit Application
PERMIT NUMBER: r 4 l6
PERMIT FEE:
❑ Commercial IrResidential
SITE ADDRESS: }% . 330\40 (E d9 , r-(-r1,/Y
Spe\cG.,,i 1 kAAA. ctRwm
Building Owner _
-
Name: e-TC04. r
Phone:
Fax:
Address: Al not, Eote a r I
J <fL
Cit C.: f, Mr
J I n
State:
Zip' C y r0 l 2
/
Contractor -
Name, 7
y�r CrPhone:
4
'1/('- y -mg..
!1 i rY
Fax:
Address:
til. 33A0 d5., r kD�,
City:
5 eL.e�X
State
LAA
Zip �r
9 a1 a
License No:
City Bust ess Lic:
Contact
Name:
Phone:
DESCRIPTION OF WORK
# OF UNITS X
COST = . TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
X
56 00
2
URINALS
X
56 00
3
TUBS
X
$600
SHOWERS (PER TRAP),
BATH, STALL, ON-SITE BUILT
X
56 00 •
5.
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, -
X-RAY, FOOD, PREP/CULINARY MEAT
X
56 00
6
DISHWASHER'
X
56 00
7
CLOTHES WASHER
X
$600
8
GARBAGE DISPOSAL
X
56 00
9
WATER SOFTENER
X
$6 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
$6 00
13
FOUNTAINS, DRINKING
X
$6 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56 00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56 00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, 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
56 00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56 00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$600 '
20
MISCELLANEOUS PLUMBING FIXTURE
X
56 00
21
PRIVATE SEWAGE DISPOSAL/SYS
X
520 00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15 00
METHOD OF PAYMENT:
❑CASH EI CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE
REVISED 8/26/05
EXPIRES'
VIN'
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
LI 02-