2013, 08-13 Permit App: BLD-2013-1600 Sprinkler Connection4g 13 13 05:18a
•i Permit Center
simialt 71707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development nww.spokanevallev.ms
Plumbing Permit Application
®. Valley
❑ Commercial
p.1
Project # dtet-13-16CC
0Cr'rstirr-•
PERMIT NUMBER:
PERMITFEE: 1 3 7f117
gResidential
SITE ADDRESS: 1 G1 Z LN C C LT
c I
'.ov rChlfVll I CE.NTER
1 SUB 1
Building Owner /n C n r e i.` it e r J -e I
,_,_
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Name: Phone:
Fax:
Address:
CI 2-C). N C O r- c. /n C. - f ' Cit, Lia e,:y
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State: (.0$:).
Zip: ��cj e b
Contractor Fo Z t r e•/ (y.Ia.s,. r�i»t: kLt•'r •
For
Name: Phone:(
Fax:
!1C C1�y�
Address: PO I,D T,� (04.1q 1 `"' I; itY-✓pOkgC aa t
State: 4,0 .Ly
Zip: 9 7 L7
License No: F OREv&s ci (O /A8 CityBusiness Lie:
Contact Lr Sc, ceind.e,c ciee-l2- Tim/
Name: Phone:
DESCRIPTION OF WORK
#OF UNITS X COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
35.00
r.
2
URINALS
X
$6,C0
3
TUBS
X
36 00
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
x
56.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTIUTY, JANITOR PHOTO.
X-RAY, FOOD, PREPICULINARY MEAT
X
$5.00
6
DISHWASHER
x
$e00
7
CLOTHES WASHER
X
S6.00
6
GARBAGE DISPOSAL
X
35.00
9
WATER SOFTENER
x
10
11
12
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
X
X
36.00
36.00
COL
13 FOUNTAINS. DRINKING
X
35 00
WATER PIPING/DRAIN-IN WASTE,
14 1 VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
55.00
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
55.00
16
WATER USING DEVICE
ICE ANOR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARSONATOR, SWAMP
COOLER
X
$5.00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS. TANKS. '
BOILERS
X
55.00
18
INTERCEPTORS
GREASE TRAP, SAND TPAP,
CHEMICAL HOLDING TANK
X
$800
19
MED;CAL GAS (per outlet)
NITROUS. OXYGEN
X
36.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
5600
21
PRIVATE SEWAGE DISPOSAL/SYS
X
520.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
515.00
METHOD OF PAYMENT:
DCASH' ❑ CHECR SISA ❑ MC
'Cards
REDACTED
AUTHORIZED SIGNATUB Er .
REVISED tV2NM
EXPIRES
VIN`
REDACTE
V
SUBTOTAL
PROCESSING FEE!
535,00
TOTAL PERMIT FEE DUE:
This document originally contained confidential credit card
information which was redacted pursuant to RCW 19.255.010
and the original document destroyed pursuant to SOS DAN
GS2014-030.