2005, 11-23 Permit App: 05004455 Plumbing Fixtures '� Permit Center
Sm'( 11707 E Sprague Ave,Suite 106 •
p �sVali Spokane Valley,WA 99206 PERMIT NUMBER:
�/ ���y (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.sookanevalley.ore.com
Plumbing Permit Application ❑ Commercial El Residential
SITE ADDRESS: 41 -;b ? E S c.L a P.e,le-
Building owner h tel"- -T AA.,.,AA.,.,r.t 4-11vt•e AS L i-e--
Name: n p t iv.1 .J# 6',Le S Phone: Fax:
Address: 1 Z..3 I A 12,1 t A v-e /V E city.Lctic.e. euetjState:[,t/}'} Zip: l?,y2rr
Contractor (/0,-11.4.e....._ Q i.c 1 14- Ria $....,....e i L C
Name: / i 1%%. ''0 t Phone: 2/7- /y'(I Fax: 3 4-i_ -0257
Address: Z/
O 0$- E ( G 1 5 " P City: j✓)d State: b.() Zip: `'J y .2 3
License No: V G'.I(,l 2 G) k t c s k City Business/ License No:
Contact `T`; 14,1/4. Z—U 114.e J
Name: Phone: .D. 1-7-/44(
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00 =
3 TUBS I X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6.00 =
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $8.00 =
X-RAY,FOOD,PREP/CULINARY MEAT ' /I`
6 DISHWASHER I X $6.00 =
7 CLOTHES WASHER I 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 =
I
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE I 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 I 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 f 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 t/26ro5