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2005, 03-28 Permit App: 05000994 Cross Connect Device CS---9 /4( PLUMBING PERMIT APPLICATION Community Development Department 'ail mifiliii\e% Building Division Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106 For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206 Project Address: j zS S '-`���,,r G� •Permit Use: ,_o --)f... S(,: •,N. • Owner: .1..._\-o L 6 , ,A,,, ; r.-. S •�,,.-nom Phone (Daytime Contact): ojcI '1 4 ?17 Mailing Address0 $11)6 ,., r.-1,4 e.., .4.G,,„ Un`la LA.)ft G.30 a City State Zip Code . Contractor: Ot,a,r�.A,-- ii; p(1\( : ,;.,,,\ • License#: Phone#: 9�7 -4,)-31) Mailing Address: City State Zip Code 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 = • LAVS/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� = • 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE _ X $6.00 = 'ROOF DRAINS/OVERFLOW 12 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, 17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS I X $6.00 = es CCI GREASE TRAP,SAND TRAP, 18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 = _ 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 - MISCELLANEOUS PLUMBING • 20 FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = • SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE 0 CASH 0 CHECK 0 VISA 0 MASTERCARD .$35.00 DATE: EXPIRES: TOTAL PERMIT FEE DUE: H-I . G BANKCARD NUMBER: AUTHORIZED SIGNATURE: •