2004, 05-21 Permit App: BLD-04-04416 Plumbing Fixturesgrpoliane
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Developmentpartmt
Builisent
on
11707 E. Sprague Avenue, -Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: 1 111 •S . 6,.,P,--\ Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address: /n� S (‘--Vv---L__ (C)48-1—
n� city State Zip Code
D l u Irr'ra i nP (C)n License #: (I0a C!'f ISI i`7Phone #: �5--
Contractor:_ ...
• •
Mailing Address: S'ra' State Zip Code
-- 3_+0.y City
* QF TOTAL.
UNITS X COST a AMOUNT
DESCRIPTION OF WORK
1
2
3
4
5
TOILETS
WATER CLOSET, BIDETS
1
X I $6.00
URINALS
TUBS
r
I
X I $6.00
X I $6.00
SHOWERS (PER TRAP)
SINKS
BATH, STALL, ON-SITE BUILT
X I $6.00
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
6
7
8
9
10
11
DISHWASHER
X I $6.00
X ( $6.00
CLOTHES WASHER
X 1 $6.00
GARBAGE DISPOSAL
WATER SOFTENER
X 1 $6.00
xf $6.00
L
ELECTRIC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
12
13
14
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
$6.00
$6.00
X I $6.00
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
TOR
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X I $6.00
16
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
19
MEDICAL GAS (per outlet)
PLUMBING FIXTURE
20
MISCELLANEOUS
METHOD OF PAYMENT:
0 CASH
0 CHECK
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
GRINDER SUMP PUMP
X I $6.00
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
X l $6.00
X I $6.00
X I $6.00
x l $6.00
x l $6.00
❑ VISA
EXPIRES:
0 MASTERCARD
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
$35.00