2008, 04-08 Permit App: 08001282 Cross ConnectSirioicar
0000Ualley
Community Development
Plumbing Permit
Permit Center
11703 E Sprague Ave, Suite 13-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Www S
Application n Commercial
okancvallev.oru
PERMIT NUMBER: 'icy 262.
PERMIT FEE:
Residential
SITE ADDRESS: I I2? (.1'• /r44 h,QF
Building Owner
-
-
Name II rative-1
6ravC1 .
. Phone: 509_939-7335 Fax:
Address: (I 24
III
I•, At P- K. e t--
City $ poKis 4e
V¢ (it,"
State: wfh
Zip
192_1 6
Contractor
Name: 1{0 c
0' n - i.._Phone:
Fax
Address:
City
State:
Zip
License No:
City Business Lic:
Contact
Name:
Phone:
DESCRIPTION OF WORK
#OF UNITS X COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
X $6.00
2
URINALS
X $6.00
3
TUBS
X $6 00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X $6 00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X $600
6
DISHWASHER
X $600
7
CLOTHES WASHER
X $600
8
GARBAGE DISPOSAL
X $6 00
9
WATER SOFTENER
X $6 00
10
ELECTRIC WATER HEATER
NOTE. IF GAS, SEE MECHANICAL
X $6 00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X $600
12
ROOF DRAINS/OVERFLOW DRAINS
X $6.00
13
FOUNTAINS, DRINKING
X $600
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 $600
17
CROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS,
BOILERS
0 $6 00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X $6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X $6 00
20
MISCELLANEOUS PLUMBING FIXTURE
X $6.00
21
PRIVATE SEWAGE DISPOSAUSYS
X $20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X $1500
METHOD OF PAYMENT:
CASH 0 CHECK 0 VISA
Card#
0 MC
EXPIRES:
VIN:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: