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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 -