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2003, 09-22 Permit App: BLD-03-02537 Bathroom S w CITY OF OS°\ONO, do,,Valley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone:(509)688-0036 Fax:(509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: /Z / ZO E, Jed(P./ tit jtoL,„Q,),, y, 6.0.4 gg2I6 ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: PERMIT DESCRIPTION: vieL,, TBUILDING PERMIT a CHANGE IN USE a GRADING D MANUFACTURED HOME ElRELOCATION SIGN Eit TENANT QOTHER OWNER / APPLICANT INFORMATION OWNER: ()C)-(lit""-I APPLICANT: PHONE: SS 92-©LI97 FAX: PHONE: _ FAX: ADDRESS: (2 q ZO (-_ vu«eY" 1 S®o"✓`4 z�6 ADDRESS: CITY,STATE,ZIP CITY,STATE,ZIP ®CONTRACTOR: ARCHITECT: PHONE: FAX: PHONE: FAX: ADDRESS: ADDRESS: CITY,.STATE,ZIP CITY,STATE,ZIP WA ST CONTRACTOR LICENSE# CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT:`r C O 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT: BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT: NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: DATE: I STAFF: - METHOD OFPA YMENT: ® ® 0 • VISA CASH CHECK BANKCARDS; EXPIRES: VIN# AUTHORIZED SIGNATURE. Scart 01 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone p0.r ` .ne Spokane Valley,WA 99206 509-688-0037-Fax 4.-000Valley Plumbing Permit Application PROJECT I29 Zo E. 0,Ilevw./ PERMIT ADDRESS:A' �,t 06_1le,f Qoi4 (-�QZ/4, USE: OWNER: (moo` e PHONE(Daytime Contact): d'97_pc/Q7 MAILING ADDRESS: Sam (street) (city/state) (ZIP) CONTRACTOR: Sa�^^P LICENSE#: MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) • PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS I X $6 = 5 6 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6 = ' ,6 5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, e LAUNDRY,UTILITY,JANITOR,PHOTO,X- / X $6 V RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER X $6 = 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 12 FOUNTAINS,DRINKING X $6 - 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, WASTE,VENT,PLUMBING REVERSALS X $6 = REVERSAL 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, STEAMER,PROOFER,CARBONATOR, X $6 = SWAMP COOLER 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 - R.P.B.P.D.FOR:VATS,TANKS,BOILERS 17 SPRINKLER SYSTEM X $25 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 = HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 - 20 MISC.PLUMBING FIXTURE X $6 = SUBTOTAL: METHOD OF PAYMENT E ' • m • 'last PLUS PROCESSING FEE: $35.00 ❑ CASH ❑ CHECK COMMEL__. ... TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: