2007, 04-05 Permit App: 07001142 Plumbing FixturesPermit Center
S i rkan' a 11707 E Sprague Ave, Suite 106
4000Valley
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development w w.spokanevallev.ora
Plumbing Permit Application
PERMIT NUMBER: I
PERMIT FEE:
❑ Commercial (y Residential
7
SITE ADDRESS: Z'J is 3. 514 h r 5 e (�--c SPO (Ca. r e (i a / i y / U>ff' eiq Zo (,
Building Owner
Name: ' i ,r. d V0eSS� I tenet,
Phone: (SO5 ) g12I — 0 `f06, Fax:
�! / — / �os(p
Address: -Zc{ J s
S• SU r v' ,, 5
(LA
City: SPD (
h
Ilii Hey ey State:
WA
zip: 1S Z d (a
Contractor
I
Name: O
n, V.
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact eI L
we ,I.-,,,,, r
Name:
Phone: cc,
e
D ___/,,, 6 4)
DESCRIPTION OF WORK
# OF UNITS
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
X
$6.00
5
SINKS
LAVS/BASINS, 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
$6.00
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:
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: