2005, 01-31 Permit App: 05000279 Piping PLUMBING PERMIT APPLICATION Community Develoannt Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
de/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: I 3 Z G Cj4 Permit Use: Li Q.0 CAI O
Owner: _i►7.#,_,) Q i 1 ii‘_ Phone (Daytime Contact): ca -7 -4 7 4 4
Mailing Address:
City State Zip Code
Contractor: , License#: Phone#:
Mailing Address:
City State Zip Code
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 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 00 =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6 00 -
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, to 45,----°
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,
17 CROSS CONNECTION DEVICE AND R.P.B P.D. FOR: VATS,TANKS,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 =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 - -
21 PRIVATE SEWAGE DISPOSAL/SYS , X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X_ $15 00
SUBTOTAL 4, d 0
METHOD OF PAYMENT:
PROCESSING FEE
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
°
DATE: EXPIRES: TOTAL PERMITFEE DUE: 41 4?
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: