2005, 05-26 Permit App: 05001805 Plumbing FixturesPLUMBING PERMIT APPLICATION Community Development Department
Building Division
n Phone: (509) 688-0036; Ft:"(509) 688-0037 11707 E. Sprague Avenue, Suite 106
siVaIII
For Inspections, Call (509) 688-0054 Spokane Valley, WA ��9}}9206
Permit Use:
Phone (Daytime Contact):
Project Address:
Owner. ye .5,
Ven ,q)
Mailing Address: SAX X» to
Contractor. m s �. nor
Mai ing Address:
City
State Zip Code
License #: Phone #:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST .
I.
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
58.00
=
et -p0
2
URINALS
X
$6.00
=
3
TUBS
X
$8.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
56.00
=
/ .00
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
/
X
56.00
=
4 .CO
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
36.00
=.
9
WATER SOFTENER
X
36.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
36.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
{
X
36.00
=
4 -en
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$8.00
=
18
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR"SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND RP.B.P.D. FOR VATS, TANKS, BOILERS
X
56.00
=-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
GREASE
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAVSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK ❑ VISA ❑ MASTERCARD
DATE EXPIRES:
SUBTOTAL
/�
e2 Z. Da
PROCESSING FEE
TOTAL. PERMIT FEE DUE:
�-335.00
41 S7 ? Q0
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: