2006, 10-26 Permit App: 06004301 Plumbing Fixtures ' Permit Center
sn, ime 11707 E Sprague Ave,Suite 106
W, alley Spokane Valley,WA 99206 PERMIT NUMBER: Lip l
(509)688-0036 FAX:(509)688-0037 OCT 20PERMIT FEE: 5, J
Community Development www,-„nokanevallev.ora
Plumbing Perinit'Application ❑ Comb el cial P1 I 'i n al``
SITE ADDRESS: r .r� 0 t (/ hyie ,/v Aye_ i ' `'
Building Owner!/ �/ C,7 p/_
Name: _ `l�imirt" 7�C/—f—''� 47,0 Phone" /:J7 _,,E_,,E .,7 5— Fax:
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Address: r City: State: Zip:
Contractor -7,7' /2,.,etjcj r C'X --e_
Name: ^�y ��r>v C �` Phone:3 _v3- , 3 ?Fax:
Address: , 'C:7 City: > State: Zip: z
y �' S� � '� r ce ��e 60/7-- ?tom
License No: City Business Lic:
Contact
Name: Phone:
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 =
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, i X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
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 =
AREA,CASE,COIL,TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 = •
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, A
14 VENT,PLUMBING,REVERSAL REVERSALS Y X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS 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
METHOD OF PAYMENT: r-2?r
PROCESSING FEE
OCASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# //�f VIN: TOTAL PERMIT FEE DUE: 5 l r en
/74
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AUTHORIZED SIGNATURE:
REVISED 8/26/05