2007, 09-18 Permit App: 07003715 Plumbing Fixtures Permit Center
1170
Sj)O�" e 11703 E Sprague Ave,Suite B-3
`� Spokane Valley,WA 99206 PERMIT NUMBER:
Valley.
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
www.spokanevalley.org
Community Development
Plumbing Permit Application H Commercial Z Residential
SITE ADDRESS:
Building Owner
Name: Phone: 93 Fax:
Address: 33 ac/ , /7 F' CIJ 4-vc_ City:�.J;JG�,C/� e ` I���// t/ State: Gil A. Zip: `7£,)i(,)Contractor o .-& t)� JJJ ✓
Name: Sam1 3 Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: vis Y� Phone: q 7 q_ 9� 9
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS , X $6.00 = /2
2 URINALS X $6.00 =
3 TUBS r� X $6.00 = 12_
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT ) X $6.00 = /2_
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, i X $6.00 =
L
X-RAY,FOOD,PREP/CULINARY MEAT // /
6 DISHWASHER ' X $6.00 = 6
7 CLOTHES WASHER I X $6.00 = G
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 = 6
AREA,CASE,COIL TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS 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 =
SUBTOTAL
METHOD OF PAYMENT: _
❑CASH (4 CHECK ❑VISA ❑MC PROCESSING FEE
/, IVEp BY $35.00
cIr L , ��
Card# vlrFi:SP°KANE VAI I m TOTAL PERMIT FEE DUE:
SEP 8 2067
AUTHORIZED SIGNATURE:
REVISED 8/26/05 PERMIT CENTER
BY: