2008, 11-20 Permit App: 08004576 Water Heater Permit Center 2177 c
ct„rA _ 11703 E Sprague Ave,Suite B-3
PERMIT NUMBER:
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: y ("
Community Development permitcenter(cr�,spokanevallev.org
Plumbing Permit Application n Commercial If Residential
SITE ADDRESS: L dr I U E 77/ J`,O k (/6v-647 ?( D /‘
Building Owner rr)) ,/cc
Name: ' ( (1U` C E Phonep(1 f (z7 ? Fax:
Address: pc7 LL./ " City.cs 4-4....4,.....A V -ICState: Zip: {?D/ /
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: Phone:
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 DISHWASHERX $6.00 =
7 CLOTHES WASHER 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 = 0-,---0 3
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
ECASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# z/ VIN: TOTAL PERMIT FEE DUE:
/
AUTHORIZED SIGNATURE:l/V t l (; y¢v//1` V V/ (1d/�)- 1 ,c 4
REVISED 8/26/05