2006, 03-10 Permit App: 06000780 Plumbing FixturesSpokane
Ie'
Community Development
Permit Center
1 1 707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX. (509)688-0037
,,\aw spokanevaile; ore.
Plumbing Permit Application
SITE ADDRESS: !'J / v
n Commercial
PERMIT NUMBER: Q ��
PERMIT FEE: �i
Residential
Building Owner
NameG
. vti,' Ch54-.
>;.cLl 12r,,__ IC C'l
Phone 9'Zy£ _ 94C/
Fax:
Address: - (c,0Z A/ . S,�// i yo, LA
City:s')bICClv-'-Q vc I(f1/ State
1�iA
vV
Zip 99Z%:�
Contractor
Name
Phone
Fax
z
c z -r i
Address:
`ZO"Z E . "Tli,orp C
Y`�
City•
State
W/4
7
Zip
99 z'—
S�7e�KCt,tiC
License No
�U q st , -,- 0L..,1-7._ Cn
.
City Business Lic: ti
` `7c) L c'
Contact
Name
/CO Iii i 1Phone:
-� OA c -S
9 z 6-7y-ro
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
X
$6.00
3
TUBS
X
56 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
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 HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
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
C„ O 0
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
20
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
CASH ❑ CHECK 0 VISA 0 MC EXPIRES:
Card# VIN
AUTHORIZED SIGNATURE:
REVISED 8/26105
SUBTOTAL
G.c_Do
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
PI/. 00