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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 • sp 7 6.) -v\;L v I/ !/"fit 5 9.2O c 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