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2009, 02-27 Permit App: 09000472 Plumbing FixturesPermit Center e 11703 E Sprague Ave, Suite B-3 ` al Spokane Valley, WA 99206 Yd(509)688-0036 FAX: (509)688-0037 Community Development penniteenter@spokanevallev.org Plumbing Permit Applicationn Commercial SITE ADDRESS: 2124 E M/e YLE A - PERMIT NUMBER: PERMIT FEE: ❑ Residential Building Owner Name: g2.,�, 0/4-1/13 Phone: 95 U_ 6 Y z. / 7 Fax: Address: (� iZ I � — City: n State: Zip: Contractor / Name:fro Phone: a S_/ _ 8b !J S Fax: Address: 660e ,„ / ,, � City: 3,Y ��-v4 CaZFS State: Zip: c /6 License No: ✓1 , ,N'l 10 FYeI 51 / 3 L T� City Business Lic: Contact Name: /! !/ I I W C 022. rl.� Phone: i -- DESCRIPTION DESCRIPTION OF WORK # 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 5 SHOWERS (PER TRAP) SINKS BATH, STALL, ON-SITE BUILT X $6.00 LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT X $6.00 6 DISHWASHER X $6.00 7 CLOTHES WASHER X $6.00 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 $6.00 12 ROOF DRAINS/OVERFLOW 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 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 DISPOSAL/SYS X $20.00 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 METHOD OF PAYMENT: ECASH ❑ CHECK ❑ VISA ❑ MC Card# AUTHORIZED SIGNATURE: REVISED 8/26/05 EXPIRES: VIN: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: