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2005, 12-19 Permit App: 05004712 Plumbing Fixtures
_ �\ Permit Center Spokane 11707 E Sprague Ave, Suite 106 jey Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development wwwsookanevallev.ora.com Plumbing Permit Application ❑ Commercial PERMIT NUMBER:7171/ B(esidential PERMIT FEE: SITE ADDRESS: y'o30 S, coUO.pte61F seo?K l/A-%(.(.� W _ Buildingowner/). .. .,. . _ # OF UNITS Name: Utter- E. SL '.' n \ k J CSS, cos Phone: SU q ri1 2-2..9 CD Fax: = TOTAL AMOUNT Address: 9130 5 . WOQpP f P City: 5Pdle_ Vosell�y State: b (- Zip: gc1)p6 ' Contractor .. J, = ... . n ,, 11,, Name: %A.0Jt Fo lass Co&, T�,�T1.W Phone: 901J L19qPC. Fax:. Address: 3071? G -Ica City :$.e'_ 1/g4ie, State: ln)A Zip: q ,>04, License No: \DRL' 951 a-- -7- 4ttV Cit usiness LiseNo: Contact $6.00 =- Name: 5 Arn E Phone: BATH. STALL, ON-SITE BUILT 1 AUTHORIZED SIGNATURE: REVISED 8r26/05 DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSELBIDETS 1 X $6.00 = �' C%CP 2 URINALS X $6.00 • 3 TUBS X $6.00 =- 4 SHOWERS (PER TRAP) BATH. STALL, ON-SITE BUILT 1 X 56.00 = p 5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT I X 56.00 = ., 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 = 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS, DRINKING X 56.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING. REVERSAL NSTALLATION, ALTERATION, REPAIR REVERSALS X 56.00 = 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X 56.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER. HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER X $6.00 = 17 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X $6.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X 56.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X 520.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: 0 CASH 0 CHECK Card# SUBTOTAL 0 VISA 0 MASTERCARD PROCESSING FEE 535.00 EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8r26/05