2007, 06-12 Permit App: 07002228 Plumbing Fixtures Permit Center (1.;2:716-/`3
Spo"kane 11707 E Sprague Ave,Suite 106 1
PERMIT NUMBER )63 96
......*Valley Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 7 �__
Community Development www,spokanevallev.ore PERMIT FEE: �A
Plumbing Permit Application ❑ Commercial VC Residential
SITE ADDRESS: 10 1 4,z. Ai l t.)--zs--6 -C i`-L
Building Owner'T ig ea L'!-L L. �14 v7 N
Name: D 412 2 c-LL_ L. E i- V ,N Phone: 9_,,`�'49_,4S Fax: $ I _0s—
OS 7 S
Address: ii P 7 i iti,ile,
ft P w/Ltk 12_j) Ci y: 5P0 t(/).-.,CI ul 17 State: to W- Zip:C/9 j2)6
Contractor A I -v-,L.,e-ao L) j
Name: D ti_(212E-LL. L er9_v iM-e., Phone: ct —ac G3' Fax: s'-‘^t/ _ O 3 7 5
Address: Ci � State: LU p_ Zi 19.j to
j �a 7 N M✓Ic=/�-/'z��Fu R.
�,1j �'� S/�o l�� Zip:
19.
No: y�l T.Z. G City Business Lie: 6610 — ,f i/ —
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Contact 27ARR 1?LL 1_. (64✓ 1 w `(
Name: it, 'I Phone: -7 .le C� a(2 t .L L V-S-6 -.940 1 —
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS � X $6.00 = 4, °_.52._
2 URINALS X $6.00 = n
3 TUBS 1 X $6.00 = )d,. 00
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X $6.00 = to.0 O
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
3 I y,
6 DISHWASHER X $6.00 = , t,, 0e)
7 CLOTHES WASHER I X $6.00 = 6, °O
8 GARBAGE DISPOSAL 1 X $6.00 = �, (l,
9 WATER SOFTENER X $6.00 = //
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL 1 X $6.00 = tGr '2
AREA,CASE,COIL,TRENCH, //
11 FLOOR DRAINS CONDENSATE I- X $6.00 = to/ (J
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 DISPOSAVSYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X_ $15.00 =
SUBTOTAL J J 6-U
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH El CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE: 1'0` -
AUTHORIZED SIGNATURE:
REVISED 8/26/05 _