2006, 10-20 Permit App: 06004226 Piping ,'tA,�,,� Permit Center
Sfiokdn� e 1 11707 E Sprague Ave,Suite 106
po PERMIT NUMBER: (f ZZ y
Valley Spokane Valley,WA 99206
�//. (509)688-0036 FAX:(509)688-0037 L
CommunityDevelopment
www.snokanevallev.ora PERMIT FEE:
Plumbing Permit Application ❑ Commercial E Residential
SITE ADDRESS: / - e //4-7/� rte.)/97/ /LP `'—'
Building Owner et,�d A "62 c.JC,
Name: �i, / Phone: Fax:
Address: City: State: Zip:
Contractor" / /7 / Q>t}
Name: .77--- r„ Phone: Fax:
Address: fee; X4 / id City: State: Zip:
License No: L cG® i 7.41City 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, 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,
14 VENT,PLUMBING,REVERSAL REVERSALS / X $6.00 = a
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:
PROCESSING FEE
['CASH ❑CHECK 0 VISA 0 MC EXPIRES: $35.00�i
Card# VIN: TOTAL PERMIT FEE DUE: 7 /en'c",
„/- __
AUTHORIZED SIGNATURE: ! rc,c s
REVISED 8/26/05 L/J