2008, 07-18 Permit App: 08002787 Cross Connect DevicePermit Center
SPO1Ca�t3V7e 11703 E Sprague Ave, Suite B-3
alley Spokane Valley, WA 99206
(509)688-0036 FAX- (509)688-0037
Community Development permiteenteraspokanevalley org
Plumbing Permit Application ❑ Commercial
PERMIT NUMBER: r 7 7
PERMIT FEE:
❑ Residential
SITE ADDRESS: d/15" /v- Lo CG111-
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Building Owner
Name: !`r2 j
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Phone:
Fax:
Address: //S-
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State:
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Contractor
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Name:
Phone:
Fax:
Address.
City:
State:
Zip:
License No
City Business Lic:
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
56.00
13
FOUNTAINS, DRINKING
X
$6 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
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
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 DISPOSAL/SYS
X
$20 00
22
INDUSTRIAL WASTE INTERCEPTOR
x
51500
METHOD OF PAYMENT:
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES'
Card# VIN
AUTHORIZED SIGNATURE:
REVISED8/26/05
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: