2004, 05-28 Permit App: BLD-04-04462 Lawn Sprinkler 0°.%14PLUMBING PERMIT APPLICATION
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e City of Spokane Valley Community Development Department
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Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: /11210 C_ 4v . Permit Use:
Owner: -lit-AVIS Phone (Daytime Contact): 915--51.44
Mailing Address: 12.17.._.L. E-. L -- 06. ` `)20(0
City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK UNITS X COST - , 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 =
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,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, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: r X $6.00 = -
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE , X $6.00 =
METHOD OF PAYMENT: SUBTOTAL (Q.d 0
0 CASH H CHECK CI VISA EL MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: . ►► 4 v.00
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: