2007, 10-05 Permit App: 07003986 Plumbing FixturesSpokan'�"'
_ Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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Plumbing Permit Application
PERMIT NUMBER: I S ('
PERMIT FEE: Li
n Commercial Residential
SITE ADDRESS: "115 5Ov.-1h -\eru1 U JpL-)1<4YLQ') A i84.
Building Owner '
Name: t o S Q 1 i
v``lnoeso��
Phone:
5�q aao-6sJ Z
Fax:
Address: y I6 5c,u•4t t'1'e rt�i ci
CityK�YtQ Uc�JIPAr
State: ` - Zip: q
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Contractor
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Name: M r. Ro.� I
Phone:20.3 1 7 Z c�OCI J
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Fax: z Dg J l� 7
Address: Q Q c6,,,,,, 3 `
City: l , .
State: } Zip: g
License No: 7
City Busines Lic:
Contact
n
Name: �A-✓8- 0 Pec ✓"
Phone: Z.Ozj —1oL.1 g
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
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
VT( p1/4Q)3
x
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
$6.00
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
14
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION,
RE
REPAIR,
X
X
$6.00
$6.00
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
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 Q¢. CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: