2007, 11-07 Permit App: 07004466 Plumbing FixturesOS' Naftii,
Spokane
FMalley
Community Development
Plumbing Permit Application ❑ Commercial
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX• (509)688-0037
www.spokanevallcv ore
PERMIT NUMBER: Li7"4c0
PERMIT FEE: 59
2 Residential
SITE ADDRESS: / tiJ D /V • Locus/ /e D
Building Owner
Name:
XI /o,_ke.e Ts—
Phone: Fax.
Address: is /v N. Le �a sr-
q
/J. City: 5-pO✓<C.(+uc /.X%'// State:
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q
Zip: ! 1Z1j (J
Contractor
Contractor
/
/- 1
Name: 4e a.- (-x/
Phone: S ds �_�5�,�� Far
�e4c„,,/,
Address: r18o6 S. t/Nkc x2.
City: �Ztee) /1Czt S State'
wici
Zip.
55oi4.
License No.
City Business Lie.
Contact
Name
Phone
DESCRIPTION OF WORK
# OF UNITS X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56 00
2
URINALS
X
56.00
3
TUBS
X
56.00
4
SHOWERS (PER TRAP)
BATH, STALL. ON-SITE BUILT '
X
56.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY:MEAT '
X
56 00
6
DISHWASHER
X
56 00
7
. CLOTHES WASHER
X
$6.00 ..
8
GARBAGE DISPOSAL
X
5600
9
WATER SOFTENER
X
56 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
$8.00
13
FOUNTAINS, DRINKING
X
56 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56 00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB.
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
56.00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE.
AND R P.B P D. FOR VATS, -TANKS,
BOILERS
/
X
56 00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 00
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$1500
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES
VIN
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: