2003, BD03-340 Plumbing FixturesMETHOD OF
❑ CASH
DATE:
aline
valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
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PROJECT
ADDRESS' I -i _ '��� to\c c5Mc)
PERMIT
USE:
DETAILS
OWNER: \ /; elLa ^' 1„1
PHONE (Daytime Contact):
COST
MAILING ADDRESS: ,
10012_e, rn toID >rh44?c i/a1(,
99z K
(street) (city/state) (Z )
TOILETS
CONTRACTOR: tlV\P ,r/__ ee
` 14U1�� �- t�
LICENSE+1: M 4/i'I-CDU p i 0 /.5(0
MAILING ADDRESS:
` D, P�DX 33(o' Ha 'ear .�
,73?3c
PHONE P �Ntg g -
se"?
4 9—boa 1
-
( I
(street) (city/state) (ZIP)
URINALS
PLUMBING FIXTURES
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
P OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6
-
( I
2
URINALS
X
$6
-
1(
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6
4LAUNDRY,
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
�1
' S
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
/
X
$6
I .
8
GARBAGE DISPOSAL
X
$6
-
�(
9
WATER SOFTENER
X
$6
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
/
X
$6
tif
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
•
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS _ .__._
X
ss__..-
. _.. ..
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOA
SWAMP COOLER
Z
X
$6
it -
16
CROSS CONNECRON DEVICE
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D FOR: VATS, TANKS, BOILERS
X
17
SPRINKLER SYSTEM
X
$25
•
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
-
19
MEDICAL GAS Per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
❑ CHECK
VIM
I_
r--
SUBTOTAL:
Sit00
PLUS PROCESSING FEE:
$35.00
■ ■
TOTAL PERMIT FEE DUE:
f1.00
BANKCARD NUMBER
AUTHORIZED SIGNATURE: