2009, 03-30 Permit App: 09000786 Cross Connect (Sta Use O ly)
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PERMIT NUMBER: j
\' i11ey" PERMIT FEE: +"C�j(-1 3.
.0010
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
permitcenter@spokanevallev.org
PLUMBING PERMIT APPLICATION
0 COMMERCIAL ® RESIDENTIAL
1442ft L i t 0r�bo l
SITE ADDRESS:1442. "� '-WA H 4(0. 5S. 536
BUILDING OWNER NAME:GREG AND REBECCA THOMAS
NAME:GREG AND REBECCA THOMAS
ADDRESS: 144 1-2_9 C u J a
CITY:SPOKANE VALLEY STATE:WA Zip:99216
PHONE:(509)868-6462 Fax: CELL:
CONTACT NAME:
PHONE: FAX: CELL:
CONTRACTOR NAME:NW IRRIGATION AND LANDSCAPING CO.
MAILING ADDRESS:PO BOX 8754
CITY:SPOKANE STATE:WA ZIP:99203
PHONE:(509)291-4102 FAX: CELL:
CONTRACTOR LICENSE No.:NWIRRIL926MC EXPIRES:08/2010 CITY BUSINESS LICENSE
NO.: ( O2- F43. Le2S
Effective October 28, 2007 Page 1 of 2
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Plumbing Permit App.1.doc
•
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 =
LAVSBASINS,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 WATER HEATER NOTE: IF GAS,SEE MECHANICAL X $6.00 =
AREA,CASE,COIL TRENCH,
11 FLOOR DRAINS CONDENSATE X $8.00 =
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 =
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 1 X $6.00 = $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 DISPOSAUSYSX $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: $41.00
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 perrplf'Is,not rmit or approval for any violation of federal, state or local laws,codes or ordinances. 6) Plans or additional
information may be requl. to be submitted and su uently approved before this application can be processed.
Signature ;`tib 1 V� Date: 3d /o
j
1J
Method of payment: 0 Cash 0 Check ❑ Visa 0 Mastercard
Bankcard #: EXP: VIN#:
Authorized Signature:
Effective October 28, 2007 Page 2 of 2
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/Plumbing Permit App.l.doc