2004, 09-17 Permit App: BLD-04-07673 Plumibing Fixtures•01"\,,
*lane
400/Valley
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
Project Address: ,/1 /)//,004 Permit Use:
Owner: DU U4
Mailing Address:
Phone (Daytime Contact):
,% n City State Zip Code
Contractor: I feC ( see C. 5`) oc h e License #: Phone #: i-
Mailing Address: 60 2 S . //P L //
J City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
-
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
2
URINALS
X
$8.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BAN, 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
$6.00
=
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$8.00
=
•
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE W GAS, SEE MECHANICAL
X
$6.00
= ,
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH,.
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
l
X
$6,00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIREVERSALS
GRINDER, SUMP PUMP
X
X
$6.00
$6.00
=
'
15
SEWAGE EJECTOR
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, ANDR.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
=•
METHOD OF PAYMENT:
❑ CASH EI CHECK
DATE
ID VISA ❑ MASTERCARD
EXPIRES:
SUBTOTAL
/ U —
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
3, l>U
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: