2007, 07-13 Permit App: 07002709 Cross Connect� v
Permit Center
11703 E Sprague
gue Ave, Suite 8-3
Spokane Valley, WA 99206
0valley Q11e�� (509)688-0036 FAX: (509)688-0037
45000
VwMlvspokancvallcv.oro
Community Development
Plumbing Permit Application
Spokane
❑ Commercial
PERMIT NUMBER:/ 21(
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1-11
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PERMIT FEE:
Residential
ADDRESS: /63 -// 0 //ail 2.
Building Owner/
- -
Name. fie r ly ‘ L L. C. l� 1-- l(
G 7 /
Phone: ( sty //)! / Q > 7 ^ _ca
Address:
/ / h .
4
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City: .,' . 7 JVP - -a State:
I
Zip: 9
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Contractor
-
--
-
_
Name:
a /4i N Ai L
Phone: Fax:
Address:
City: State:
Zip:
License No:
City Business Lie
Contact
Name: ✓
3 r Y S. C (e
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Phone: (1'0 9/ 9 3 9- s 6 IF a'
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET BIDETS
X
56 00
2
URINALS
X
56 00
3
TUBS
X
$6 00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
x
$6 00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
56 00
6
DISHWASHER
X
56 00
7
CLOTHES WASHER
X
56 00
8
GARBAGE DISPOSAL
X
56 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
$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
56 00
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
56 00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R P B P.D FOR VATS, TANKS,
BOILERS
X
56.00
6. o0
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56 00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING FIXTURE
x
56.00
21
PRIVATE SEWAGE DISPOSAUSYS
X
520 00
22
INDUSTRIAL WASTE INTERCEPTOR
X
515.00
METHOD OF PAYMENT:
❑CASH D CHECK D VISA
Cardtt
AUTHORIZED SIGNATURE:
REVISED S/26/05
D MC
EXPIRES'
VIN
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
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