2008, 08-27 Permit App: 08003380 Plumbing FixturesS'I11Y Ll
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Va�lley
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Plumbing Permit Application
❑ Commercial
PERMIT NUMBER: -1:5-NS.J
PERMIT FEE:
Residential
SITE ADDRESS:
4oy /2A
Building Owner
Name:
Phone:q
Fax:
Address: y0 y /i/ Fc.rc %Z
City. Spfi)c.,.e v`ite>,
State:
CJS}
Zip. y92_06.
Contractor �y - /t, -1t
Name: Gnke kb.,
Phone: 16 y OS3�
Fax:
/0r /%7�
Address: N ✓�a(�City:ii�.tr.a(State:
//�Zip:
p�� /
License No: ilc,;.1
0P. 04 x q2 7C s
L
City Business Lic: 60 2
15.00
s 01
Contact r �S y�e k^
`D /C
Name:
Phone: 5 ]c) 355'3
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
6
2
URINALS
X
$6.00
3
TUBS
i
X
$6.00
6
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
iz
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
6
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 DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
❑CASH 0 CHECK 0 VISA 0 MC
Card#
AUTHORIZED SIGNATURE:
EXPIRES:
VIN:
SUBTOTAL
30
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
6S.
OV
Effective October 28, 2007
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