2009, 05-12 Permit App: 09001305 Plumbing Fixturesr /\ Permit Center
s�30�ane _+ 11703 E Sprague Ave, Suite B-3 r�
�,,�Valley Spokane Valley, WA 99206 t
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.ore
Plumbing Permit Application (l Commercial [ Residential
5-1 /.A / . e,,e4 e &//ey
PERMIT NUMBER:
SITE ADDRESS:
PERMIT FEE:
/.5'1 '
Building Owner
r
Phone: ?.2 T • 3 3 J :j
Fax:
Name:
��. � �oSe GCS' %%//
Address: �� ice_ E /I ,
City' �� . n �a e f' ��ey
State:
Zip:
Contractor
Name://,c )„, vi A,/,' /4 �j(Gct 1(k 6-#,_
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Phone:
Fax:
Address: 7/ .f /\ aC 7 / '4 y /� 1i L'
City..��DO�u 1 r� �i �! 2 r'
State:
V(64'
Zip:
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/..Z
License No: G 4 ,rr/A4 5 9 / 8 %jc
City Business Lic:
Contact 1.
Name:
Phone:
1
2
3
4
5
DESCRIPTION OF WORK
TOILETS
# OF UNITS
X
COST
TOTAL AMOUNT
WATER CLOSET, BIDETS
X
$6.00
URINALS
TUBS
X
$6.00
X
$6.00
SHOWERS (PER TRAP)
SINKS
BATH, STALL, ON-SITE BUILT
X
$6.00
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
6
7
8
9
DISHWASHER
X
$6.00
CLOTHES WASHER
X
$6.00
GARBAGE DISPOSAL
WATER SOFTENER
X
$6.00
X
$6.00
10
ELECTRIC WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
12
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
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 0 CHECK ❑ VISA 0 MC EXPIRES:
Card# VIN:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: