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2003, 01-01 Permit App: BD-03-157 Plumbing Fixtures
ci'Iirrw„ me Plumbing Permit Application 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax 0-3-15-7 PROJECT ADDRESS: 507 7 si S44).:9409 L OWNER: ` m/ ,) cp44.. 1 PERMIT USE: MAILING ADDRESS: 5a7 S S o, ZA/, (street) PHONE (Daytime Contact): /51-1/4 Z41" '°%. (city/state) / (ZIP) CONTRACTOR: ,j/ j d �DeG /j/ (424e, MAILING ADDRESS: !/ l� ) PHONE #: LICENSE*: /77W o�j�GG�JJ OD�c�%✓c /,;-4 / ‘451, (street) (city/state) (ZIP) PLUMBING FIXTURES 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 DESCRIPTION TOILETS DETAILS # OF UNITS - X URINALS TUBS WATER CLOSET, BIDETS X COST (EQUALS $6 AMOUNT X $6 SHOWERS (PER TRAP) SINKS X BATH, STALL, ON-SITE BUILT LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO; X- RAY, FOOD, PREP/CULINARY/MEAT X $6 $6 DISHWASHER X $6 CLOTHES WASHER X GARBAGE DISPOSAL WATER SOFTENER X X ELECT. HOT WATER TANK FLOOR DRAINS X NOTE: IP GAS, SEE MECHANICAL X $6 $6 $6 $6 FOUNTAINS, DRINKING AREA, CASE, COIL, TRENCH, CONDENSATE X $6 WATER PIPINGGDRAIN-IN 'WASTE, VENT;'PLUMBINC REVERSAL SEWAGE EJECTOR X INSTALLATION, ALTERATION, REPAIR, REVERSALS X $6 $6 WATER USING DEVICE GRINDER, SUMP PUMP X CROSS CONNECTION DEVICE SPRINKLER SYSTEM INTERCEPTORS ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 $6 VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. POR: VATS, TANKS, BOILERS X $6 X MEDICAL GAS per outlet GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X• $25 $6 MISC. PLUMBING FIXTURE NITROUS, OXYGEN X X $6 $6 'HOD OF PAYMENT :ASH CHECK ❑ CHECK ❑EININI 0 EXPIRES: (CARD NUMBER IORIZED SIGNATURE: SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: