2008, 10-23 Permit App: 08004106 Plumbing Fixtures Permit Center •
j� le3' 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER:
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037
Community Development www.spokanevalley.org PERMIT FEE:
Plumbing Perm" ,
Permit Application Commercial ix Residential
SITE ADDRESS: qt' J' 4 150)
Building Owner
Name: I all/110S 'Price ,
Phone: C 1W I Fax:
Address: 7 Hc Ile,w1 City: x i(ci re State: I�}1 Zip:(:1q.)/
Contractor n
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: I n a'vi Pt ice Phone: 5 (1C/o 2•zo
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DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 = 10
2 URINALS X $6.00 =
3 TUBS a X $6.00 = , 10
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 02 X $6.00 = la
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, (� X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT JU
6 DISHWASHER f X $6.00 = b
7 CLOTHES WASHER I X $6.00 = (7
8 GARBAGE DISPOSAL I X $6.00 = b
9 WATER SOFTENER X $6.00 =
10 ELECTRIC WATER HEATER NOTE: IF GAS,SEE MECHANICAL X $6.00 =
AREA,CASE,COIL,TRENCH,
11 FLOOR DRAINS CONDENSATE �, X $6.00 = ()
CZ
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 I X $6.00 = kJ
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 I.�^`
METHOD OF PAYMENT: _
PROCESSING FEE
❑CASH 0 CHECK ❑VISA 0 MC EXPIRES: /'"!$35.00
l
Card# VIN: TOTAL PERMIT FEE DUE: I{D ,O0
AUTHORIZED SIGNATURE:
REVISED 8/26/05