2008, 02-15 Permit App: 08000455 Piping w ..
Permit Center
11703 E Sprague Ave,Suite B-3 PERMIT NUMBER:
Spokane Spokane Valley,WA 99206
._Valley} (509)618-0036 FAX:(509)688-0037 PERMIT FEE: 4 I
www.spokanevalley.org
Community Development
Plumbing Permit Application yy ��❑ Commercial 0 Residential
SITE ADDRESS: "Y/,`, 0 Z G- C/l' `Y
Building Owner
Name: Phone: Fax:
Address: - L / City: State: Zip:
Contractor
Name: ,y Phone: Fax: C
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Address: j Z / ,> City: �leof rn. State: ,/t)4 Zip: 9.9 a G 6,
License No: /.S eon ja ! City Busidess Lic:
Contact �e. rr fel,
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 =
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
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 =
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. / .C' )
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 ly,
METHOD OF PAYMENT: W`/
PROCESSING FEE
OCASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VI� - TOTAL PERMIT FEE DUE: 4-//•0
AUTHORIZED SIGNATURE: 6'._„r.„- . ` f /
•
REVISED 8/26/05 '--;.-"--c;:' ... '