2004, 05-21 Permit App: BLD-04-04414 Plumbing FixturesMETHOD 0
0 CASH
DATE:
Spo'lane
.,, 0 'Ma11ey
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: i I q C
/// ��``
PERMIT
USE:
DETAILS
OWNE 1 S G , 1
W �'�'�' -t
PHONE (Daytime Contact): c9 1 _
l
-7 4
MAILIESS:
1 s I L( `-1-CideLr ir a (e) A qq DO
6.0
jP7RJA
(street) (city/state) (ZIP)
TOILETS
CO FQR: /r a ^ p f (t�� )6' nom' {
t J
LICENSE #:
X
MAILING ADDDDRESSS: a
PHONE #: •_ 5-7/
/
2
URINALS
(street) (city/state) (ZIP)
,
PLUMBING FIXTURES
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF LesI TS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
-
2
URINALS
X
$6
-
3
TUBS
X
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WAS I t;, VENT, PLUMBING
REVERSAL
INSTALLATION ALTERATION, REPAIR,
X
$6
-
AIS
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
S I EAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
CHECK
J' '
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
•
TOTAL PERMIT FEE DUE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: