2008, 02-11 Permit App: 08000378 Water Heater Permit Center
""« 11703 E Sprague Ave,Suite B-3
Walley PERMIT NUMBER: U3
'aT Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: 11f------
Community Development www.spokanevalley.org
Plumbing PermitApplication n Commercial [ 1-fl idential
SITE ADDRESS: _ g /10 �i g/L' 6
Building Owner
Name: Phone: Fax:
c��2x;a�- nL6,e gxy- 33`G��,� , a�
Address: /1 /! 0 �� /C/G City.d H y p,'N7 N�4 ey d ip: /5'.2./__6
Contractor / /
Name: 6rtPhone: Fax:
Address: I / /I b (j Si ti 7`r.) City%l y oPs/9G///lti'',S ' e /i,---c t iP ' �/,
License No: City Business Lic:
Contact ,e.."4,......_
47147
Name: Phone: 5'S'/_7 Jam/ -
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
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 WATER HEATER NOTE: IF GAS,SEE MECHANICAL / X $6.00 = 6*,O 2
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:
PROCESSING FEE
['CASH 0 CHECK 0 VISA C EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
117
AUTHORIZED SIGNATURE:
Effective October 28,2007
P:\Community Development\Forms\Building forms\Plumbing Permit Application.doc