2006, 04-03 Permit App: 06001148 Plumbing Fixtures Permit Center
"lcane 11707 E Sprague Ave,Suite 106
•
Mt"e3' PERMIT NUMBER:/�L
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037
PERMIT CommunityDevelopmentwww.spokanevallev.org
Plumbing Permit Application ❑ Commercial Residential
SITE ADDRESS:
Building Owner
Name: R V S la h /4-e 1,,,k-; Phone: `�/` 7 I 0, Fax:
Address: $C q 5 �1n o j/✓v. City: State: Zip:
Contractor k v51n-Z
'd rCS1K i
Name: (Q 'f J , Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
O
1 TOILETS WATER CLOSET,BIDETS - X $6.00 = I L
2 URINALS X $6.00 =
3 TUBS X $6.00 = c1
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 2- X $6.00 = I Z
LAVSBASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = U u
X-RAY,FOOD,PREP/CULINARY MEAT i Z.-
6
6 DISHWASHER X $6.00 =
c
7 CLOTHES WASHER ( X $6.00 = G
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
U
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 = (; 0
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 =
Ulm
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = E�
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05