2007, 08-29 Permit App: 07003402 Plumbing Fixtures , V
Permit Center 3`1 C-/--
11703
11703E Sprague Ave,Suite B-3
Spokane PERMIT NUMBER:
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: L ICS 13
/�Va11ey www.spokanevalley.org
Community Development
Plumbing Permit Application ElCommercial IN Residential
SITE ADDRESS: /1//9) 5 (01' (AOC'
Building Owner
Name: SA,' &t'o,, Phone:
. fvC— eff- Fax:
Address: Hie S ut City:,O/./ -3 t/ State: (AM, Zip: 77fe/
Contractor
Name: Phone: C c c Fax:
as 64.dic. i/ , .me_.- 5`6/- i”_?7s,
Address: ') ) / City: C c, State: Zip: V/
7� �ov � �
License No: ( Cl S p l,] /:3 L � City Busined'Lic:
Contact \LL4 A 1 I�, 11 c{ /.
Name: L t/ �`t N� Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 9— X $6.00 = t 01
(-
2 URINALS X $6.00 = // /0 j�
3 TUBS / X $6.00 = I;J .
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6.00 = W • a)
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = ��JJ COX-RAY,FOOD,PREP/CULINARY MEAT • Ic�l O
6 DISHWASHER , X $6.00 =
7 CLOTHES WASHER ( X $6.00 = 6,co
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 =
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 ElCHECK CIVISA 7j.MC EXPIRES: /n $35.00
Card# / n ,)/IN: TOTAL PERMIT FEE DUE: D v06
AUTHORIZED SIGNATURE: (,L42- r 'C /
REVISED 8/26/05