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2004, 03-22 Permit App: BLD-04-03831 Plumbing Fixtures
Siiii(�crr4 ckrjj,,O.��°,, 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone i L1.ne Spokane Va1s9y,WA 99206 509-688-0037-Fax Walley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: z..( (J ?'.74///41.,,--- USE: OWNER: ��/ � �jG �p.�& , PHONE(Daytime Contact): 9.„._ /© _.396----„PMAILING AESS: (L T�`J CJ v C /61 4 ; /4 0 id o (street) (city/state) (ZIP) CO LQR: /. o f I( a4 s. n LICENSE#: MAILING ADDRESS: a PHONE#: 3 c/ /,r S. Clcia x� c?01. � - 5�� .3 (street) (city/state) (ZIP) , PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS ( X $6 - 2 URINALS X $6 - 3 TUBS X $6 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- / X $6 = 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 $b = HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 = 20 MISC.PLUMBING FIXTURE X $6 = SUBTOTAL: METHOD OF PAYMENT • VISA' • gas._ . „° PLUS PROCESSING FEE: $35.00 El CASH El CHECK El ❑ .?= ' TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: