2005, 04-13 Permit App: 05001173 Plumbing FixturesPLUMBING PERMIT APPLICATION
of
Phone: (509) 688-0036; FAX: (50�) 688-0037
For Inspections, Call (509) 688-0054
Project Address: "� N, L-e—i
Owner.
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact): ZZ U8(oS3
Mailing Address: bio 5
City State Zip Code
Contractor: License #: Phone #:
Mailing Address: c: s a )CO ✓ e—
City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: 611)V�14 -
DESCRIPTION OF WORK
X OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
-
2
URINALS
X
$6.00
-
3
TUBS
X
$6.00
-
4
1 SHOWERS PER TRAP
BATH STALL,ONSITE BUILT
X
1 $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
1 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
$6.00
-
11
FLOOR DRAINS
AREA, CASE, COIL,TRENCH CONDENSATE
X
$6.00
-
12
ROOF DRAINSIOVERFLOW
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.D. FOR: VATS TANKS BOILERS
X
$6.00
-
16
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
-
19
MEDICAL GAS r outlet)
NITROUS, OXYGEN
X
$6.00
-
20
MISCELLANEOUS PLUMBING
FIXTURE
X 1
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
-
22
INDUSTRIAL WASTE
INTERCEPTOR
X 1
$15.00
-
METHOD OF PAYMENT:
❑ CASH CHECK [3VISA [3 MASTERCARD
MASTERCARD
DATE: EXPIRES:
SUBTOTAL
FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: 611)V�14 -