2008, 05-15 Permit App: 08001845 Plumbing Fixtures:Valley
SOokane
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 n Commercial
SITE ADDRESS: 14C L C� / Tp, ra C
PERMIT NUMBER:
PERMIT FEE: l�
❑ Residential
Building Owner /
Name: Q j� 6 4^ / 7
Phone:
Fax:
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Address: 7 2 ` ‘ c 1 /�� r" t Cr
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State: %_ //1
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Zip: /C f Z
Contractor
Name: %� co V v7 kvkj ✓i'e 1� C
Phone: //
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Fax:
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Address:/q6,
Address:��U l ,s J., ,...7: �D
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City. f1- j'eG//j ea,r, / P t
State: /�
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Zip: / Q �U b
License No: (j u jZ. c c/ t7 / K. %
City Business Lac:
Contact
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Name:
Phone: ,
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
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
15
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
X
X
$6.00
$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 DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
['CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES:
Card# VIN:
AUTHORIZED SIGNATURE:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
C1'/, 00
Effective October 28, 2007
P:\Community Development\Forms\Building forms\Plumbing Permit Application.doc