2008, 02-19 Permit App: 08000481 Plumbing FixturesSpokane
.000 Val ley
Community Development
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokanevalley.org
Plumbing Permit Application n Commercial
PERMIT NUMBER: j
PERMIT FEE:
Kesidential
es-
SITE
s
SITE ADDRESS: / / /l/ A/?0(
r,/A//may L c.
Building Owner
Name:
Phone: q
0077
Fax:
Address: 37 C/
/l/.
C 1
h E'
/2 CC
City: ‹POia✓t e
1/c- /le)/
State:
u;
Zip:
`/ 17 7/6,
Contractor
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact
Name:
Phone:
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
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
$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
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 DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
['CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
Effective October 28, 2007
P:\Community Development\Forms\Building forms\Plumbing Permit Application.doc