2006, 05-26 Permit App: 06002025 Remodelv try
Community Development
Plumbing Permit Application
11707 E Sprague Ave, Suite 1 uo
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
wvew'.svokanevallev.ora
PERMIT NUMBER: fir S -O
PERMIT FEE:53
❑ Commercial ❑ Residential
SITE ADDRESS:
Building Owner 2
Nam��� _ Q- id 0e1,95 "Y) a ( Phone: Fax:
Address: Ci State:- zillo 37
Contracto
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Name: Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
t
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL ONSITE BUILT
t
X
$6.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.D0
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
r ELECTRIC HOT WATER TANK
NOTE: IF GAS. SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.0D
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS,
BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
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
=
METHOD OF PAYMENT:
❑CASH 0 CHECK 0 VISA 0 MC
Card#
SUBTOTAL
EXPIRES:
PROCESSING FEE
$35.00
VIN:
TOTAL PERMIT FEE DUE:
AUTHORIZE SIGNATURE:
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