2005, 04-15 Permit App: 05001202 Sprinkler System PLUMBING PERMIT APPLICATION Community Development Department
1110111:44% Building Division
Phone: (509) 688-0036; FAX: (5Q9) 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
(5— if)tThr‘
Project Address: ( R) a E ( Permit Use:
Owner. t 1 c "o‘r, tie.G— c'r 1c.\, Phone(Daytime Contact): c.j <S I _ c i—`1
Mailing Address: Ya,P
} City SiecA:c,TvC State -v,_.°. A-- Zip Code CL
Contractor. S ' I 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 =
LAVS/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,CARBONATO- " ••LER
VACUUM BREA CHEC• • /
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: V• S,TANKS,BOI •S ( X $6.00 = Ca
GREASE TRAP, .N =
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
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE: . ( • UC)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: