2009, 06-02 Permit App: 09001496 Plumbing Fixtures Permit Center
i` IINft. 11703 E Sprague Ave,Suite B-3
j30Yl�aile PERMIT NUMBER:
4000.0ValleY
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokanevallev.ore -
Plumbing Permit Application n Commercial13.esideential )�
SITE ADDRESS: 80 5-- A) o g l7 i/1 l� Xi
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Building Owner F 5-e0 L' i-t/f y
Na m H �.. C (5S hl)Ck ,�P, 1�'�O/UPhone: <_d(;)309_y 4r Fax: Q
Address: / 0 5 /` b 60.i II /, /_V(/ City: {lel LAI. 4 1,/v„
/f State: , VI— Zip' / .?0, ,
Contractor _ (2 '/
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
I
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 , _
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, e X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT 1
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC WATER HEATER NOTE: IF GAS,SEE MECHANICAL X $6.00 =
AREA,CASE,COIL,TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH ❑CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05