2006, 09-28 Permit App: 06003895 Cross ConnectSg61&ne
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11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)686-0036 FAX: (509)656-0037
Community Development =' nrvtiy �+�Yanevallep ore
PERNi11 NUMBER: j'
PERMIT FEE:
Plumbing Permit Application n Commercial Residential
SITE ADDRESS: 1 — \�-
Building Owner \ ` G\ry0.2, c Le -e--
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Name:__,
Phone:'-'009Lci43_0 7
Fax:
Address:
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State:
Ziplg6 i 7Contractor
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Name:
Phone:
Fax:
Address:
City.
State:
Zip:
License No:
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City Business Lis:
Comite-
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Name:
Phone:
DESCRIPTION OF WORK
ffi OF UNITS. X COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
x
$6.00
2
URINALS
X
$6.00
3
TUBS
x
16.00
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
$6.00
5
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILffY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
x
$6.00
6
DISHWASHER
X
16.00
7
CLOTHES WASHER
X
16.00
5
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
16.00
1D
ELECTRIC HOT WATER TANK
NOTE: IF RAC, SEE MECHANICAL
x
16.00
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH,
CONDENSATE
X
16.00
12
ROOF DRAINS/OVERFLOW DRAINS
X
16.00
13
14
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
x
$6.00
NSTALLATION, ALTERATION, REPAIR
REVERSALS
X
16.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
16 DD
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
16.00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS,
BOILERS
X
16.03
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
16.00
2D
MISCELLANEOUS PLUMBING FIXTURE
X
$6.OD
21
PRIVATE SEWAGE DISPOSAL/SYS
X
120.03
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
ECASH ❑ CHECK\
Card#
VISA ❑ MC
AUTHORIZED SIGNATURE:
REVISED V2MOS
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
4-0,00