2007, 01-17 Permit App: 07000041 Plumbing Fixtures Permit Center
o k e 11707 E Sprague Ave,Suite 106 PERMIT NUMBER:
... alley Spokane Valley,WA 99206
.... Valley (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development awws0okanevallev.ors.com eSideIItial
Plumbing Permit Application ,,,, Commercial
SITE ADDRESS: ( g U (C' N . b_�{i1ax A)
Building owner
Phone: Fax:
Name:
City. State: Zip:
Address: 4 •
Contractor ii K P u4,rri /
Phone: Fax:
Name:
City: State: Zip:
Address:
License No: City Business License No:
Contact
Phone:
Name:
#OF UNITS X COST = TOTAL AMOUNT
DESCRIPTION OF WORK
1 TOILETS
WATER CLOSET,BIDETS X $6.00
)( $6.00 =
2 URINALS Z,/ X $6.00 =3 TUBS
4 SHOWERS(PER TRAP)
BATH,STALL,ON-SITE BUILT X $6.00 =
LAVSBASINS,BAR FLOOR,KITCHEN, 3 X $6� _
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO,
X-RAY,FOOD,PREP/CULINARY MEAT
X $6.00 =
6 DISHWASHER
X $6.00 =
7 CLOTHES WASHER
)( $6.00 =
8 GARBAGE DISPOSAL
X $6.00 =
9 WATER SOFTENER
10 ELECTRIC HOT WATER TANK
NOTE: IF GAS,SEE MECHANICAL X $6.00 =
I
_
11 FLOOR DRAINS
AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00
ROOF DRAINS/OVERFLOW X $6.00 =
12 DRAINS
x $6.00 =
13 FOUNTAINS,DRINKING
WATER PIPING/DRAIN-IN WASTE, NSTALLATION.AL
SALSON,REPAIR, X $6.00 =
14 VENT,PLUMBING,REVERSAL
15 SEWAGE EJECTOR
GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB, 3 X g6 00 =
16 WATER USING DEVICE STEAMER
PROOFER,CARBONATOR,SWAMP COOLER
VACUUM BREAKER,CHECK VALVE, X
17 CROSS CONNECTION DEVICE AND R'PG=
REASE TRAP,SAND TRAPBOILERS $6.00 =
18 INTERCEPTORS
CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet)
NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING X $6.00 =
20 FIXTURE X $20.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE X $15.00 =
22 INTERCEPTOR SUBTOTAL
METHOD OF PAYMENT: PROCESSING FEE
$35.00
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
Card# EXPIRES: TOTAL PERMIT FEE DUE:
REVISED 8/26105AUTHORIZED SIGNATURE: