2007, 08-15 Permit App: 07003220 Piping A
Permit Center
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�` 11707 E Sprague Ave,Suite 106
`Il'e' PERMIT NUMBER: `� �C j
Valley Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: `7
Community Development www.spokanevallev.org
Plumbing Permit Application n Commercial o( .1 Residential
SITE ADDRESS: /0/0 1 e. l."`6.--
Building Owner
Name: (2 ( -Ir cots,it
� Phone: Fax:
Address: i ,J k of ( � . City: State: Zip:
Contractor
Name: Slti/ f UM /N Phone: 1-2,,..._ /5---ti/ Fax:
Address: i g H ' Xt l IL 1 City: State: Zip:
License No: City Business Lic:
Contact
Name: —tv r� Phone: C 9 z I—5 L s
►t; CaUtLt.�..t I�t —
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, /
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
p/ASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
l Card# VIN: TOTAL PERMIT FEE DUE: 9
AUTHORIZED SIGNATURE:8/26/05