2003, 08-28 Permit App: BLD-03-02339 Plumbing FixturesPLUMBING PERMIT APPLICATION
PROJECT
DESCRIPTION
PERMIT
# OF aNrn
ADDRESS:
USE:
AMOUNT
OWNER:
n
PHONE (Daytime Contact):
_
MAILING ADDRESS:
$6
•
street
ci /state(zip)
URINALS
CONTRACTOR:
LICENSE #:
$6
4-3 s
S'
TUBS
MAILING ADDRESS:
PHONE M
X
$6
=
4
•spoKane:,
BATH, STALL, ON-SITE BUILT
WCL.
�9aolo
street
cit /state(zip)
5
PLUM&IN0' FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATLTRE:
DESCRIPTION
DETAILS
# OF aNrn
X
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
j
X
$6
•
2
URINALS
X
$6
=
3
TUBS
X
$6
=
4
SHOWERS PER TRAP
BATH, STALL, ON-SITE BUILT
X
$6
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
X
$6
Dd'
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
=
6
DISHWASHER
X
$6
7
CLOTHES WASHER
X
$6
=
8
GARBAGE DISPOSAL
X
$6
=
9
WATER SOFTENER
X
$6
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
=
11
1 FLOOR DRAINS
I
AREA, CASE, COIL, TRENCH,
$6
CONDENSATE
X
12
FOUNTAINS, DRINKING
X
$6
=
13
WATER PIPING/DRAIN4N
INSTALLATION, ALTERATION,
(
X
$6
GC9
WASTE, VENT,'
REPAIR, REVERSALS
PLUMBING REVERSAL
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
=
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
X
$6
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
_
16
CROSS CONNECTION
VACUUM BREAKER, CHECK
X
$6
DEVICE
VALVE, AND R.P.B.P.D. FOR.
VATS, SUMPS, TANKS, BOILERS
=
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
$6
CHEMICAL HOLDING TANK
JX
_
19 1
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
201
MISC PLUMBING FIXTURE
X
$6
=
❑ CASH
SUBTOTAL
PLUS PROCESSING
❑ CHECK d ❑
PAX D PERMM WILL ONLY BE ACCEPTED WITH PAYM8Nr
$35.00
OPAMNORCMUC.MW
FEE
TOTAL PERMIT FEE
n.�. .,.........
DUE
S q 0 d
BANKCARD NUMBER:
AUTHORIZED SIGNATLTRE: