2005, 09-19 Permit App: 05003435 Plumbing Fixturesv ' U61
Permit Permit Cent
S rt�tSLllle 11707 E Sprague Ave, Suite 106
ley Spokane Valley, WA 99206
.000 (509)688-0036 FAX: (509)688-0037
Community Development w-ww.spokanevallev.org.com
Plumbing Permit Application
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•
o Commercial
PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS g`1 () 5 Fa S j
Building owner \C.{J-\e--\ L
j7&i-
it OF UNITS
X
COST
Name:
Phone:
C-4, X -- X 73
Fax
WATER CLOSET, BIDETS
Address: L;( Os E"-....1.,:",....4.1-
City
State
Zip
Contractor
URINALS
X
$6.00
Name: cJ Q / //per
Ql / 1t
Phone:
1lk3- 6 -<,, ,Tei
Fax:
Address:
V `
,' `-
=
City
State
Zip
License No:
X
City Business License No:
=
Contact cALLA .0.4z,I1
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
c
...-3 -
X
$6.00
Name:
Phone:
DISHWASHER
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
it 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,__4.
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
c
...-3 -
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
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
$6.00
=
14
99
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
7
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 DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X_
$15.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card#
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05