2008, 03-25 Permit App: 08001050 Cross Connect Device4
Permit Center
Spokane 11703 E Sprague Ave, Suite 8-3
a.00Ualley
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development wwwspokanevullev.ore
Plumbing Permit Application [
SITE ADDRESS: ( //hp ` p 2 O
1
Commercial
PERMIT NUMBER: J- coo
PERMIT FEE:
esidential
Building Owner
-
Name.
3„sar1. 6 M Cl`�
Phone' ax:
��?�- �s3
Address: tit I iD N I\ C, � „
llL---.111000
City.5 _ .1 \ _ _ State:
f -C'+ `>: \ v\71
\.43,1 Zip: Zip: .--2t)/.1
Contractor
Name- i
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Phone: Fax:
s�� yssy �����
�� yis� —3�J y Z
Address: ^
�o: I y f �1�
Qt State:
y.'S� �,.� �,1
Zip
v. )� X97 1'Z
License No:
City Bus es5 Lie:
Contact
Name-
Phone:
DESCRIPTION OF WORK
# OF UNITS X
COST
TOTAL AMOUNT
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
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
$6 00
10
ELECTRIC WATER HEATER
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
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$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 0 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
Card#
❑ CHECK [] VISA ❑ MC
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES
VIN
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: