2004, 04-07 Permit App: BLD-04-03988 Lawn Sprinklersif�lane
Lal selValley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact): /5-01739
Project Address: 53 It 5, Go c4 w
Owner: CA VIM/ Mt'J cAI9/_!:Y
<A 44
Mailing Address:
Contractor:
Mailing Address
o,c' a 5(T'vrNL sn e #: city
City
lv337 56-7--0/ Past file( 5
State Zip Code
Phone#: 75-5"/ 7 30
63853'
Zip Code
State
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$600
=
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAYS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
X
$600
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6 00
=
9
WATER SOFTENER
X
$600
=
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
INSTALLATION, ALTERATION,
. REPAIR, REVERSALS
X
$600
=
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
t I
X
$6.00
=
(j V
/ Il
V
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$600
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA ❑ MASTERCARD
DATE. EXPIRES'
SUBTOTAL
PROCESSING FEE
$35.007
TOTAL PERMIT FEE DUE:
`,
I I' 0 L )
BANKCARD NUMBER
AUTHORIZED SIGNATURE: