2004, 11-30 Permit App: 04009216 Water PipingIl
PLUMBING PERMIT'APPthCATION
ne Phone: (509) 688-0036; FAX: (509) 688-0037
diVa1' For Inspections, CaII (509) 688-0054
Project Address: 94'b) F //ld5ft. sh hi,P
Owner: 72 a4' t %Frey 5Lt''yle'"
Mailing Address: Y' 70 f os L . t€ aye (Y enatfee.. (.t/i) 1;90%�/
City
Contractor. !lame- DIAi Ae-fr License #:
Permit Use:
Oti-9-16
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact): 5° —990-90t I
State Zip Code 2
Phone #: .16 9 -9Z5' - a 4o6
Mailing Address: Set Ave_
City
State
Zip Code
BANKCARD NUMBER: 1400
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6 00
=
2
URINALS
X
5600
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56 00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY. FOOD, PREP/CULINARY MEAT
X
56.00
=
6
DISHWASHER
X
5600
7
CLOTHES WASHER
X
56 00
=
8
GARBAGE DISPOSAL
X
$6 00
=
9
WATER SOFTENER
X
56.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56 00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6 00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,II
REVERSALS
X
5600
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56_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.139 D. FOR VATS, TANKS, BOILERS
X
56 00
18
INTERCEPTORS
GREASE TRAP. SAND TRAP,
CHEMICAL HOLDING TANK
X
55 00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 Do
=
20
MISCELLANEOUS PLUMBING
FURURE'
X
56.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20 00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
535.0/0/
TOTAL PERMIT FEE DUE:
(p. (')
BANKCARD NUMBER: 1400
AUTHORIZED SIGNATURE: