2004, 03-15 Permit App: BLD-04-03778 Plumbing FixturesSdi'anso,
jValley
Project Address: 8 /<u 0
Owner: 'TO 5 %Z 4,, v,
Mailing Address:
SW klfr. )E
Contractor: `/00 r PL B
Mailing Address:
3/2z 6( tss
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):
S,Pv.
City
License #: 0 3 3 Pfvi
City
SState
Phone #:
State
70 Co
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
(
X
$6.00
=
t2 0 0
2
URINALS
X
$6.00
=
3
TUBS
(
X
$6.00
=
- 0 0
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
2
X
$6.00
=
i '7/.0 O
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
(p .0 V
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
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=
D Q
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
=
METHOD OF PAYMENT:
❑ CASH 2 0 CHECK 0 VISA 0 MASTERCARD
DATE: 3 I, e if
I 0 EXPIRES:
SUBTOTAL
3 to. 0 0
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
/
' l j OD
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code