2005, 04-29 Permit App: 05001371 Plumbing FixturesSPka" De
dolValleY
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
( .)
Project Address: i 1/ 7 V? 0 goI -& Permit Use:
Owner. 1 C� L A/ ,Q i` /� / /y I� Phone (Daytime Contact): 02 - a J
C % / , ? f�
Mailing Address: Le- / f 70,/ 44//7 ' J/ d")'6 i! ,
/ Ci, State Zip Code
gfiContractor. License #: Phone #:
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
DESCRIPTION
WATER CLOSET, BIDETS
fli
X
$6.00
=
1
TOILETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
TRAP)
BATH, STALL, ON-SITE BUILT
i
X
$6.00
=
4
5
SHOWERS (PER
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
DISHWASHER
X
$6.00
6
7
CLOTHES WASHER
-1
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
1
1
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
56.E
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 4 CHECK
MAIM.
0 VISA 0 MASTERCARD
FXPIRFS-
SUBTOTAL
PROCESSING FEE
$35.
TOTAL PERMIT FEE DUE:
91
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: