2007, 10-23 Permit App: 07004250 Plumbing Fixtures a
Permit Center
a ]1703 E Sprague Ave,Suite B-3
SpoTxkane Spokane Valley,WA 99206 PERMIT NUMBER:440
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Valley (509)688-0036 FAX:(509)688-0037 PERMIT FEE: f )/
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Community Development
Plumbing Permit Application n Commercial I I Residential
SITE ADDRESS: - W coo -o q_C
Building Owner
Name: S kOS CI 0:3. Phone: 9 9 Q S Fax:
Address: 35 (� ,�s City: ` � Oci11 State: L )Q Zip: Q'�/
Contractor ce\ �vtg Y(k)
V `� ( �'(p
Name: 1 `� Phone: Fax:
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Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: Phone:
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 =
I
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 • =
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT i
6 DISHWASHER I X $6.00 =I
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL I 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 ❑CHECK ❑VISA ❑MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05