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2008, 12-16 Permit App: 08004801 Plumbing Fixtures4 Z Community Development Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 perm itcenter@sookaneval lev. ora Plumbing Permit Application n Commercial PERMIT NUMBER: 4% O\ PERMIT FEE: ✓ Residential SITE ADDRESS: /q5 5 Z % oiek Building Owner Name: /f /�� /y` 7 Phone: 2 --t., O_ 9/ S g Fax: Address: /, 9, ; Z- E 4, ,vE. City: s/-oi /p/,)te: �y0,_ J'' Zip: Contractor 4/ A /)/4, hi / Name: Phone: ax Address: Ir,F City: L_State: �-� .-Zip: License No: City Business c: Contact Name: Phone: DESCRIPTION OF WORK TOILETS WATER CLOSET, BIDETS # OF UNITS X COST TOTAL AMOUNT 3 X $6.00 2 URINALS X $6.00 3 TUBS X $6.00 4 5 6 SHOWERS PER TRAP SINKS DISHWASHER BATH, STALL, ON-SITE BUILT 7 CLOTHES WASHER LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY. FOOD PREP/CULINARY MEAT I X X X $6.00 $6.00 $6.00 X $6.00 8 GARBAGE DISPOSAL X $6.00 9 WATER SOFTENER X $6.00 10 ELECTRIC WATER HEATER NOTE: IF GAS, SEE MECHANICAL X $6.00 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6.00 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 13 FOUNTAINS, DRINKING X $6.00 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 15 16 17 18 SEWAGE EJECTOR WATER USING DEVICE CROSS CONNECTION DEVICE INTERCEPTORS GRINDER, SUMP PUMP ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 $6.00 X X $6.00 $6.00 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X $6.00 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 METHOD OF PAYMENT: ❑CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES: Card# VIN: AUTHORIZED SIGNATURE: REVISED 8/26/05 SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: