2014, 07-25 Permit App: BLD-2014-1770 Cross Connection07/25/2014 04:25 FAX
.�Valley
1
Permit Center Project
11707 L Sprague Ave, Suiteil06
Spokane Valley, WA 99206
(509)688-0036 PAX: 009)688-0037
Community Development www.rookancvollcv;orb
Plumbing Permit Application
RECEIVED
[77
E 001
PERMIT NUMBER:
PERMIT FEE: o
❑ Com'Mercial ZO.L I Residential)
SrrE ADDRESS: ' 1 2+ Q F G r a f i P% C c .,
Building Owner
Name; r0.Son
Address, it 2-1 et
WI mo 115
SUR it
r,aatr r`.,�rr,
Phone
RFI/ a 1
ll
Fax:
(mace- W1 Jt
Contractor
Name: F0 re,V er Gre.e e S P rl r' c jj S
Address: ir ole ta44
LiccnseNO: Forgv5ar'1b Ibs2!
Contac
Nemo : J_ISA. SAndtr
DESCRIPTION OF WORK
1 TOILETS
City: SPokaa-t, Uct,114r7'
Phone: 4%c\ _1Z'jy
State;
zip: q cj 10 6
City: 5 poka,,.e_
City Business Lie: ;-p 0 ka, n
Fax5111 9 l9b- 2611 -
State, [N O. Zip ;g 92/7 —
dieh• 09o7 -
Phone: Co Luc)._ /23
OF UNITS
X
COST
TOTAL AMOUNT
2 URINALS
3 TUBS
4 SHOWERS (PER TRAP)
6 SINKS
WATER CLOSET. BIDETS
x
x
58.00
x
56.00
16,00
6 DISHWASHER
7 CLOTHES WASHER
8 GARBAGE DISPOSAL
BATH, STALL, ONSITE BUILT
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
x
$6,00
56,00
se.DD
x
$8 00
9
WATER SOFTENER
x
50.00
10 ELECTRIC HOT WATER TANK
11 FLOOR DRAINS
12 ROOF DRAINS/OVERFLOW DRAINS
13 FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
14 VENT, PLUMBING. REVERSAL
15 SEWAGE EJECTOR
15 WATER USING DEVICE
NOTE. IF GAS, SEE MECHANICAL
AREA. CASE, COIL TRENCH,
CONDENSATE
x
56 00
x
58 00
50,00
x
58.00
56.00
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
5000
GRINDER, SUMP PUMP
ICE AN/OR COFFEE MAKER. HOSE BIB,
STEAMER
pROOFER. CARBONATOR, SWAMP
COOLER
56,00
56.00
17 CROSS CONNECTION DEVICE
18 INTERCEPTORS
19 MEDICAL GAS (per outlet)
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS.
20 MISCELLANEOUS PLUMBING FIXTURE
21 PRIVATE SEWAGE DISPOSAL/SYS
BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLOING TANK
NITROUS, OXYGEN
58.00
X
x
56 00
56.00
58.00
520.00
22 INDUSTRIAL WASTE INTERCEPTOR
METHOD OF PAYMENT:
x 51500
SUBTOTAL
42 0 0
PROCESSING FEE
TOTAL PERMIT FEE DUE:
535.00
LfI DO
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