2005, 11-29 Permit App: 05004495 Plumbing FixturesSfiorkane'
Walley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.sookanevallev.ore.com
Plumbing Permit Application
PERMIT NUMBER:
PERMIT FEE:
❑'Commercial ❑ Residential
(33 --
SITE ADDRESS: S (S S* SG-1(NC) CC
Building owner
DESCRIPTION OF WORK
Name: C- 4/C-6 "-" / t A ) f' 56 L(
Phone: Fax:
Address: SU L.i 57. 5 O/l.E-),--i4
City: ??j44- State: 4✓4 Zip:
Contractor
TOTAL AMOUNT
Name: 4 iT 6. B0 0 (-( T L U rf'i f 1/ V/
Phone: 2 0-)( r [t Fax:
L -
Address: 0 2 \ A(/. I,GGc,/g r
city cPk. L1 1 State: I -v4- Zip: 942oC
License No: 1-1-6 P P f_ /14 cj (2i Q Q (-ill I q C.
City Business License No: 6 02 Co 7 - 112
I
Contact
Name:'� `�
1 L RA -E.' �. f�cc-- ? e (6 -YL-
Phone: 2 -7 a — 1 L 1 y
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
It OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
I
X
$6.00
=
r,, —
`r
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAYS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
$6.00
=
C2 -_
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
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:
0 CASH g CHECK
Card#
SUBTOTAL
` C
I
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
j '3, O/Q
AUTHORIZED SIGNATURE:
REVISED 8/26/05