2005, 04-01 Permit App: 05001031 Plumbing Fixtures;r
diValley
Project Address:
PLUMBING PERMIT APRLIGATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
3`.32i riled( 2d
Owner: R2.40&?-+ Lok -S c2
Mailing Address: L ( L
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact):
Ity
Contractor: 6 4resf6/A4-, 14., License #:
Mailing Address:
1
State
Zip Code
Phone #: -2-57-g05-19
ity
State Zip Code
DESCRIPTION OF WORK
TOILETS
WATER CLOSET, BIDETS
* OF UNITS
2
URINALS
3
TUBS
X
X
X
COST
56.00
$6.00
TOTAL AMOUNT
4
SHOWERS (PER TRAP)
5
SINKS
6
DISHWASHER
BATH, STALL, ON-SITE BUILT
X
S6.00
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD,PREP/CULINARY MEAT
1
t
X
X
$6.00
$6.00
7
CLOTHES WASHER
X
8
GARBAGE DISPOSAL
X
9
WATER SOFTENER
X
10
ELECTRIC HOT WATER TANK
11
12
FLOOR DRAINS
'ROOF DRAINS/OVERFLOW
DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
AREA, CASE, COIL, TRENCH, CONDENSATE
X
13
14
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
15
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
16
17
18
WATER USING DEVICE
CROSS CONNECTION DEVICE
INTERCEPTORS
19 MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING
20 FIXTURE
GRINDER, SUMP PUMP
X
X
X
X
56.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
X
$6.00
X
$6.00
X
X
$6.00
$6.00
21 PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
22 INTERCEPTOR
METHOD OF PAYMENT:
❑ CASH 0 CHECK
DATE:
BANKCARD NUMBER:
❑ VISA
EXPIRES:
0 MASTERCARD
S
X
X
X
X
UBTO
$6.00
$6.00
$20.00 =
$15.00
TAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
$35.00
AUTHORIZED SIGNATURE: