2008, 08-07 Permit App: 08003077 Water Softener ~ Permit Center
Sc�rvof 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER:F-313.71
pokane Spokane Valley,WA 99206
r (509)688-0036 FAX:(509)688-0037
ijValley wwwspokanevalley.ore PERMIT FEE:
14
Community Development
Plumbing Permit Application n Commercial kResidential
SITE ADDRESS: i 39 1 ' Silo P 4v e-
Building Owner f
Name: act a r k S Oa tO ,+e (-- Phone: a ^�?/ '( Fax: /�
Address: +?FIN s�w Aye_ City: ��,�^ n e-,Nv�cll i e y State: c< 4 Zip: 9Z/6
Contractor 11 �ce�
Name: S l l in 1'kM f(` S,.}.pr Phone: 957_6s-07 Fax:
Address: s-2-2_0Y` A) e--0-,..,-,_ C�- City: Com!11/e,yl e State: (J 4- Zip: 99212
License No:SPD !� A_F115 ? -3-2--- City Bus-me'ss'Liic: ' ` C S
Contact l'�/'T l' r�Cl
Name: Phone:
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 = &•0-79
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00
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 DISPOSAL/SYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05