2008, 02-04 Permit App: 08000297 Plumbing FixturesPermit Center
.kerne 11703 E Sprague Ave, Suite B-3
IWA99206
� 1 Spokane -0 36 (509)
(509)688-0036 FAX: (509)688-0037
Community Development wwwspokanevalley.org
Plumbing Permit Application n Commercial
PERMIT NUMBER: .1C1
PERMIT FEE:
-71
Residential
SITE ADDRESS: 6 t% 5 /Z e +✓ LE' k fC )c c r-1 G) I>a
Building Owner
Name:
Phone: Fax:
Address: 6 % C (, Ge zrv%
City: C 7 P 0k4tAY vu`‘.e/ State:
Zip:
Contractor
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Name: l r 11 « <n Hk e 1 J .lM 10 ( :� IV L
Phone: s 601 - 7 6 S J1 LA\_ttFax:
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4
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Address: Gj G 1 S 1/,1 T -r t,, r` C, S +l U P
City: ej 0 O 1 C co ,� State:
1.4)A
Zip:
42
License No: iA No1/41 6 0 'Z(,`7ciS 3
City Business Lic:
Contact cti1,,,\A17 }M r_n � j�142
Name:
Phone: S D c' 7 t K ,_i ti- I
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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
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
3
X
$6.00
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
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
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,
AND R.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
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
Effective October 28, 2007
P:\Community Development\Forms\Building forms\Plumbing Permit Application.doc