2004, 08-25 Permit App: BLD-04-07459 Plumbing FixturesProject Address: 1(C-3 E • skt-WOOLJ UA
)
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildtngDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Owner: tt I I K,E TUX Phone (Daytime Contact): C1:514- 75 7 Cc
Mailing Address: i � � E E. 51.Awori L J,
(ow
Contractor:
Mailing Address:
1(-A(UC lr' C Y 1,04q • (AO/(
City State
License #: Phone #:
Zip Code
City
State Zip Code
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
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
X
$6.00
PREP/CULINARY/MEAT
DISHWASHER
$6.00
CLOTHES WASHER _
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10 ELECTRIC HOT WATER TANK
11
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
x
x
X
$6.00
$6.00
$6.00
$6.00
$6.00
12
ROOF DRAINS/OVERFLOW DRAINS
X
13
FOUNTAINS, DRINKING
X
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
$6.00
$6.00
15
SEWAGE EJECTOR
18
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
19
MEDICAL GAS (per outlet)
20 MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
Q CASH Q CHECK
DATE:
GRINDER, SUMP PUMP
/QR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
VACUUM BREAKER CHEC
`VALV AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
X
$6.00
x
$6.00
Cc OD
X
$6.00
(.W
$6.00
X
$6.00
X
$6.00
0 VISA 0 MASTERCARD
EXPIRES:
BANKCARD NUMBER:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
1- 1•00
AUTHORIZED SIGNATURE:
— 07969