2006, 03-10 Permit App: 06000778 Plumbing FixturesPermit Center
Spokane: 11707 E Sprague Ave, Suite 106
Val l lei. Spokane Valley, WA 99206
40000
V (509)688-0036 FAX (509)688-0037
Community Development ,v\\.w spokanevaile,. or_'
Plumbing Permit Application
SITE ADDRESS:
PIs- 5 ..
PERMIT NUMBER: O77 Y
PERMIT FEE
❑ Commercial aResidential
I��tS
Building
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Owner
Name: J 1 G 0.,..0,:,\.4 it OC..— IC- Phone: 9 Z y - iC/ G q Fax:
Address' (D o L N 5 `1) 1 t v'C, r,
City Sj7 O XG ✓i c L2Gl llz% i State. t A YV /A
Zip:99 z
Contractor j4(A0.\C11C Lc,se.c,?
Name: /4 52 Lc,,n5,.....„4 peCr
Phone: ZG, %G5 O Fax 9-z. to OZ 7 /
Address: / Z Z o .Z 1 - or
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City- 5 PoK et,c f rri- r State: W4
Zip. 99 z o G
pe-
License No: (�liv0,e) L `
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City Business Lic L J -t -? O 2 0
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Contact
Name: Kct v i ✓x 70„,t i S
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Phone: qZ 6 / � /s('
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DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
2
TOI LETS
WATER CLOSET, BIDETS
X
56 00
URINALS
X
56.00
3
TUBS
X
$600
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
56.00
6
DISHWASHER
X
56.00
7
CLOTHES WASHER
X
56.00
8
9
GARBAGE DISPOSAL
WATER SOFTENER
X
$6.00
X
56.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
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
56 00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R. P.B. P. D. FOR: VATS, TANKS,
BOILERS
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
1
X
$6.00
O v
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN'.
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
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