2008, 01-28 Permit App: 08000246 Sink• • e
Oat.NPermit Center
Spokane 11703 E Sprague Ave, Suite B-3
jh Spokane Valley, WA 99206
ral�e� (509)688-0036 FAX: (509)688-0037
Community Development www sookanevallev ore
Plumbing Permit Application n Commercial EXT Residential
PERMIT NUMBER: 0Z4 6
PERMIT FEE:
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SFI'E ADDRESS:
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Building Owner _ _-- -
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Name. Ciro q I �� /
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Phone: Sq/ -3 E
Address: I'rn
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Contractor
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Name:
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Fax:
Phone: 2S 1 0 Z G 3
Address:
State:
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Zip:
License No:
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City B65 -ass Lie:
Contact
Name:
Phone:
DESCRIPTION OF WORK
# OF UNITS X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56 00
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY. UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
6
DISHWASHER
x
56.00
7
CLOTHES WASHER
X
56 00
8
GARBAGE DISPOSAL
X
56 00
9
WATER SOFTENER
X
56.00
10
ELECTRIC WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56 00
12
ROOF DRAINS/OVERFLOW DRAINS
X
56 00
13
FOUNTAINS DRINKING
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
x
56 00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56 00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER. HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
56 00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK VALVE,
AND R P.B.P D FOR VATS, TANKS,
BOILERS
X
56.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56 00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 00
20
MISCELLANEOUS PLUMBING FIXTURE
X
56 00
21
PRIVATE SEWAGE DISPOSAL/SYS
x
520 00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15 00
METHOD OF PAYMENT:
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES
Card# VIN
AUTHORIZED SIGNATURE:
SUBTOTAL
PROCESSING FEE
$36.00
TOTAL PERMIT FEE DUE:
Effective October 28, 2007
P:\Community Development \Forms\Building forms\Plumbing Permit Application.doc