2005, 04-13 Permit App: 05001170 Water PumpProject Address:
Owner. Wei/
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX:1509j688-0037
For Inspections, Call (509) 688-0054
mcir /4 Ie +--Lvt leW Permit Use:
Phone (Daytime Contact): 91t V -5-6 y
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Mailing Address:
_ City State Zip Code
Contractor. ,.,�t\LCtkO 1()"3 License#:/A'4-!LNL4 3,c. hone#: qiV-5-4,s-(54
Mai ing Address' �i (6 (2).1 `7.0 t 2 Rci O 11„ c \Lo L.3 O., 93 t/ 4
City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTOR OF WORK
# OF UNITS
X
COST
a
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE 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
$6.00
=
7
CLOTHES 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
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56 00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALIATION, 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
$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
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
58.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
58.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
o CASH 3 CHECK
DATE
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: