2014, 11-12 Permit App: BLD-2014-2746 Plumbing FixturesPermit Center r i C Ct
*Wane` 11707 E Sprague Ave, uite f 06 D
Valle Spokane Valley, WA 206 E
y (509)688-0036 FAX: (09)688-0037
Community Development www.spokanevallev.or .corn
❑ C the1r ia1014j
Plumbing Permit Application
SITE ADDRESS 3 81' $ /Her G� " r lr p F -F 9 CENTER
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
a ...
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
II
F . - �.
_,
"` L -
-Phone:
1 - ;
Fax Fax v ' .-'
2
4 - 8
=
Address:
02. /V
Su - J04"
r
City--
141
��_.-
=
Zi
21
v'.'-'t_�
.:a.�Name:
-atiL�fa".. ?'-.t'4"'FG�V
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- 51Y1`�
.. n ..�"`�.n.,.t?.ta .• ..,L,
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i• -",a F.� hz ' ?«n
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Phone:
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
_-
Address:
34.
6
DISHWASHER
Ci
i
State
$6.00
=
Zi .
7
License No:
1
X
City Business License No:
=
a
8
GARBAGE DISPOSAL
s42.Z
S
:
�.
-
....
4.
9
�-y
-
X
$6.00
Name:
1 C.i'f
Phone:
21 8. - c/g Z
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
•
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
$6.00
=
i g
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
.,Z.
X
$6.00
=
1.2
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
34.
6
DISHWASHER
i
X
$6.00
=
4
7
CLOTHES WASHER
1
X
$6.00
=
a
8
GARBAGE DISPOSAL
I1
X
$6.00
=
4.
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
1
X
$6.00
=
4.
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:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
It . aro
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
I ?J 1. Clp
AUTHORIZED SIGNATURE:
REVISED 8/26/05