2009, 06-16 Permit App: 09001763 Plumbing Fixtures '. #4..N Permit Center
`n' +a 11703 E Sprague Ave,Suite B-3
�pO ail PERMIT NUMBER:
Spokane Valley,WA 99206 i 7 +��
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(509)688-0036 FAX:(509)688-0037 PERMIT FEE: t 7
Community Development www.spokanevallev.org
Plumbing Permit Application n Commercial Residential
SITE ADDRESS: 1 9 C (- P N V e- `J ‘N--`t
Building Owner /
Name: 1 ,n v C 3 (4,,,--p,.S rr.(_-',1-. A Phone: _s-',,/1 Z si`- ilS: -2 Fax:
Address: i 7 `l G 4.-1 L 4\,v 6 0_•,,,)A`-P City: C f.......;-,:c_NAC 4.c.::s State: : a Zip: `l Z L, k to
Contractor
Name: - !�c N.% Phone: Fax:
Address: (1
C i C" City: State: Zip:
License No: I r City Business Lic:
Contact
Name: c,,:F r--Py--is G (4 ) S! ' c 1L i Phone: %D t -c'L (4.S-Y.3 9 C 3 . y L S-(✓
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 2 X $6.00 = / .2.
2 URINALS X $6.00 =
a3 TUBS / X $6.00 = - 6-�
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6.00 = 6------
LAVS/BASINS,
y-'—
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, S °'
X $6.00 =
O
X-RAY,FOOD,PREP/CULINARY MEAT
oC
6 DISHWASHER / X $6.00 = 4,'-
. // m
7 CLOTHES WASHER _ ( X $6.00 = Co 0
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC WATER HEATER NOTE: IF GAS,SEE MECHANICAL X $6.00 =
AREA,CASE,COIL,TRENCH, / co ;
11 FLOOR DRAINS CONDENSATE - X $6.00 = r �"k
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 = // G
15 SEWAGE EJECTOR GRINDER,SUMP PUMP / X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE • STEAMER X $6.00 = a e'
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 CHECK 0 VISA 0 MC EXPIRES: j $35.00
Card# VIN: TOTAL PERMIT FEE DUE: /' 1 2_,S:'�—
•
AUTHORIZED SIGNATURE: ,"--I5- )
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REVISED 8/26/05