2007, 11-08 Permit App: 07004490 Plumbing FixturesS`ie
_,..Valley
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037.
www.spokanevalley.ora
Plumbing Permit Application
n Commercial
PERMIT NUMBER:q9c-
PERMIT FEE:
Residential
SITE ADDRESS: X 5 `, C-1017 .6? . r w 2 /)
Building Owner
Name:
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T"i 5/0 e �`� Phone:
Fax:
Address:
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City:
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State:
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Contractor
_
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact
Name:
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 (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
. $6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
$6.00 •
10
ELECTRIC WATER HEATER
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
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
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
1
X
$6.00
X
$6.00
19
20
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES:
Card# VIN:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: