2010, 10-07 Permit App: 10003283 Plumbing FixturesSlibliane""‘
4,0Valley
PERMIT NUMBER:
PERMIT FEE:
(Staff Use Only)
CITY OF SPOKANE VALLEY
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
pgrmitcenter@spokanevaiiey.org
PLUMBING PERMIT APPLICATION
❑ COMMERCIAL RESIDENTIAL
SITE ADDRESS:
g, 7)/6 uTAH ,4V1.
BUILDING OWNER NAME:
NAME:
,4aMA cosrlav
ADDRESS: E, ! ( I lo 14 M/ ,4 lit
CITY: -./20/14/1/k V4t IZ/ STATE: ZIP: / 22 / 7
PHONE: FAX -- CELL: 3954961
CONTACT NAME: 5At,
PHONE:
FAX: CELL:
CONTRACTOR NAME: /aim t Ol'4M 6iL-
MAILING ADDRESS:
CITY:
STATE: ZIP:
PHONE:
FAX: CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
Effective October 28, 2007 Page 1 of 2
C:\Mc & Turk Items\Permit Forms\Spokane Valley\Plumbing Permit App.1 spokane valley.doc
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
Signature
Date: /0- % v % d
Method of payment: 0 Cash 0 Check
Bankcard #:
0 Visa 0 Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007
C:\Mc & Turk Items\Permit Forms\Spokane Valley\Plumbing Permit App.1 spokane valley.doc
Page 2 of 2
DESCRIPTION OF WORK
# 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
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 WATER HEATER
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
=
Q i
G --^
15
SEWAGE EJECTOR Vir.
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
=
SUBTOTAL
/ p
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
Gk4/ -
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be required to be submitted and subsequently approved before this application can be processed.
Signature
Date: /0- % v % d
Method of payment: 0 Cash 0 Check
Bankcard #:
0 Visa 0 Mastercard
EXP: VIN#:
Authorized Signature:
Effective October 28, 2007
C:\Mc & Turk Items\Permit Forms\Spokane Valley\Plumbing Permit App.1 spokane valley.doc
Page 2 of 2