2005, 05-26 Permit App: 05001809 Plumbing FixturesPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAM: (AV) 688-0037
For Inspections, CaII (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
620
8 _ 05 r) T
Project Address: g O 0 Lf In Permit Use:
Owner. i\J / Mr ck. e y J= I'c c o- Phone (Daytime Contact):
Mailing Addres : f gO9 L /Ylk _s- re v4 w v% py 1,
Clty State Zip Code
Contractor: 2n/0co,..r.Fon License#: Phone#:
Mailing Address: L/b P7 S r f 2 led
61-11.44 J+ 9239V
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
- X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
,
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
\
X
$6.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,I
X-RAY, FOOD. PREP/CULINARY MEAT
X
56.00
=
6
DISHWASHER
X
5600
=
7
CLOTHES WASHER
X
$6.00
=
6
GARBAGE DISPOSAL
X
56.00
=
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
$6.00
=
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
=
18
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
$6.00
=
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
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
SUBTOTAL
r'
t 6 00
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
5 , 00
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: