2005, 09-21 Permit App: 05003471 Plumbing Fixtures 0.0111%,..... Permit Center
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S`iokane11707 E Sprague Ave,Suite 106
svalley Spokane Valley,WA 99206 PERMIT NUMBER:
.// (509)688-0036 FAX:(509)688-0037 ✓✓ �'
Community Development www.spokanevalley.ore.com PERMIT FEE: S
Plumbing Permit Application o Commercial o Residential
SITE ADDRESS
Building owner <-4,- 5,A,,,e pi- Zb e v. q j� Ry
Name: SL s4-ai (�-- /bp./v biQb 3 e� hone: 1'-[o_,�/jZ.7 Fax 72-4 -- (� 2- 9 2-
Address: p 0.ac3ZQ 13 7/7 ( `� City Sip - Ij 4 State /oaf Zip 99 Z!3
Contractor 4I A4. A, 6
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Name: 4., ID/p ✓l 6/l d," Phone/5'3 S—6-/til Fax: ! 2 q-2..../ `t��
Address: L.ve-P j i ✓ City i./d».G,4/4.. State U-A... Zip,L'(:•-•
License No: 1 74/2_,/
1 A P 19 `L k/A City Business Lice'nse No:
Contact 1 vi, 1+0.-1,1--1,1 J
Name: Phone: �37 ----C:,7 2-7
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS I 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,
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 DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
0 CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
Card# EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: REVISED 8/26/05