2004, 10-21 Permit App: BLD-04-07985 Plumbing FixturesSPlank e
Walley
Project Address: 4'2 M/ /?%LDena /C'/'
Owner: (17,/`we Cori hoer ci
Mailing Address: gt:: VA/, Air
Contractor MK rce l -,Act1Ylrirlc.f Sovor P5
Mailing Address: (n6z //ay IAfe t IV
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact): 9,z N 3 3 V c
License #:
City
State
Phone #:
CI f l n,:L/i&Jf 1)A-/7,
City
Zip Code
95/— 575.a
w -
9Cog7
State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST =
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00 =
(o . 0 0
2
URINALS
X
$6.00 =/
3
TUBS
X
$6.00 =
(0 O CO
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00 =
5
SINKS
_
LAVSBASINS, BAR, FLOOR
KITCHEN, LAUNDRY, tfTILITY,
JANITOR. PHOTO, X-RAY, FOOD,
PREP/CIILINARYIMEAT -
X
$6.0o =
GPO
6
DISHWASHER
X
$6.00 —
7
CLOTHES WASHER
X
$6.00 =
8
GARBAGE DISPOSAL
X
$6.00 r-
9
9
WATER SOFTENER
X
$6.00 =
10
ELECTRIC HOT WATER TANK
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
56.00 =
13
FOUNTAINS, DRINKING
X
$5.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING. REVERSAL
INSTALLATION, ALTERATION,
REPAIR. REVERSALS
X
$6.00
15
SEWAGE EJEGTORGRINDER
SUMP PUMP
X
$8.00 =
(n. 60
16
WATER USING DEVICE
ICEAN/OR COFFEE MAKER,
HOSE BIB STEAMER, PROOFER
CARBONATOR, SWAMP COOLER
X
$6.00 =
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK '
VALVE, AND RP.BP.D. FOR
X
$8.00
VATS TANKS, BOILERS
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 =
(��, HOD OF PAYMENT:
0 CHECK Q VISA Q MASTERCARD
DATE: EXPIRES:
SUBTOTAL
oZ 11.0°lCASH
PROCESSING FEE
$35.003
TOTAL PERMIT FEE DUE:
S4 , o 0
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: