2005, 11-28 Permit App: 05004468 SewerSpokane
Valley
Community Development
Plumbing Permit
SITE ADDRESS:
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)689-003;
www.spokanevalley.org.com
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PERMIT NUMBER:
PERMIT FEE:
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Buildin g owner
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# OF UNITS
Name:
COST
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Phone: Fax:
Address: q(
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City: tate: j A3 Zip: cy 6-4
Contractor
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2 URINALS
Name: LA
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Phone: 7_ S o(� Fax:
Address:
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City: vv State: ILI Zip: 3
License No:
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City Business License No:
Contact
4 SHOW PER TRAP
BATH, STALL, ON-SITE BUILT
Name:
$6.00
-
Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
WATER CLOSET, BIDETS
X
$6.00
=
2 URINALS
X
$6.00
-
3 T
X
$6.00
-
4 SHOW PER TRAP
BATH, STALL, ON-SITE BUILT
X
$6.00
-
5 SINK
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6 DISHWASHER
X
$6.00
=
7 CLOT HES WASHER .--
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
-
ROOF DRAINS/OVERFLOW
12 DRAINS
X
$6.00
=
13 FOUTAI S, DRINKIN
X
$6.00
-
WAT R /DRAIN -IN WASTE,
14 PLUMBING, REVE
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
-
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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
=
MISCELLANEOUS PLUMBING
20 FIXTURE
X
$6.00
=
21 PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
-
INDUSTRIAL WASTE
22 INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
Card# , EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: _ REVISED 8126105
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