2007, 08-23 Permit App: 07003325 Water Piping, Drain1
Spbkan<N'
.000 Valley
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX. (509)688-0037
Community Development www spokanevallev oro
Plumbing Permit Application [f Commercial
PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS: _'C70 / A/ • LDC: e2ra.^✓
Building Owner _
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Name: 'p I i i 61 it,_
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Phone:
Fax:
Address
City: S7r /. �
State: �/y
Zip ii, --z_
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& C.00e4:r P,/
Contractor!-
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Name:.....xSiti./aii 6/w", yr6/•
Phone' .7 7 ,, Silt
Fax:
Address: 1 Y '-I I a f ili k
City 24.:..•4444.i
State: L,/o_
Zip: 579 / c,
License No:
City Business Lie.
Contact:' - -
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Name: Tz%A[N( (0viu.vvt l Ne
Phone: ? 1_11 - :5141
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
X
$6 00
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6 DO
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
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
I
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 DO
17
CROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK VALVE.
AND R.P B.P D. FOR: VATS, TANKS,
BOILERS
X
$6 00
16
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
$15.00
METHOD OF PAYMENT:
/}CASH D CHECK D VISA DMC
Card#
AUTHORIZED SIGNATURE...A 1y
REVISED 826/05
EXPIRES -
VIN.
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
C//