1994, 02-07 Permit App: 94000943 Plumbing Fixtures PLUMBING PERMIT APPLICATION
PROJECT ADDRESS:
OWNER: J` 612.✓L l-1�l (�(-(�S PHONE: 3 1
MAILING ADDR : / qU ( ---7 L W( (i„)---7-e__ /..„1/4.) S Po
tq
(street (city/state) (zip)
CONTRACTOR: 1 l.CAMit, (77 c v 0 — ( LICENSE: pLLr✓, (3 0 gi C i3
PHONE:
MAILING ADDRESS: J) �O CO M i.,((,,e-4-0.; c P U (,oxi- q 9 Zv b
(street) (city/state) (zip)
PLUMBING FIXITJRES #OF MULTI- COST
DESCRIPTION I DETAIL UNITS PLIED BY /UNIT EQUALS AMOUNT
E02 TOILETS WATER CLOSETS,BIDETS 0-7_ x $6 = $
Bbl URINALS - x $6 = $
B04 TUBS BATH,JACUZZI,SPA,GARDEN 2- x $6 = $
B05 SHOWERS(per trap) BASE,STALL,ON-SITE BUILD X $6 = $
B06 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, X $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO, li
X-RAY,FOOD(PREP/CULINARY/MEAT)
B07 DISHWASHER - x $6 = $
BOS CLOTHES WASHER - x $6 = $
B09 GARBAGE DISPOSAL/GRINDER - x $6 = $
B10 WATER SOF 1'tNER - x $6 = $
B11 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $
112 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE I x $6 = $
BO ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
1414 FOUNTAINS,DRINKING - x $6 = $
B15 WATER PIPING/DRAIN—WASTE—VENT INSTALLATION,ALTERATION OR REPAIR X $6 = $
B.16 SEWAGE EJECTORS GRINDER,SUMP PUMP ( X $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, X $6 = $
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLERS
B18 CROSS—CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, X $6 = $
AND R.P.B.P.D.FOR:VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
B19 INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN X $6 = $
B21 MISCELLANEOUS FIXTURES x $6 = $
Subtotal
NOTE: MINIMUM PERMIT FEE IS $35.00 PLUS: PROCESSING FEE $25.00
TOTAL PERMIT FEE DUE $
SIGNATURE: ., .
A t / AP
SPOKANE COUNTY DIVISION OF BUILDINGS
WEST 1026 BROADWAY AVENUE*SPOKANE,WA 99260*(509)456-3675
MASrER\PWMPERM.HND