2007, 06-06 Permit App: 07002109 Piping Permit Center
S`" "lane 11707E Sprague Ave,Suite 106 (Q
Walley Spokane Valley,WA 99206 PERMIT NUMBER:�'
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: C.4 I
Community Development www,spokanevallev.ore
Plumbing Permit Application n Commercial ,Residential
SITE ADDRESS: _ / /L// Z El t.
Building Owner
Name: ,`['/ 1 I
-i ;1 -�I Phone: Fax:
t V4 '>
Address: 1 L/17 112 ��� City: State: Zip:
Contractor '
Name: Phone: C" Fax:
Address: f Lil b ti ilitL i City: l'%'ue,v"it'Z:?.c,3 State: Zip: 97 t ,6
License No: City Business Lic:
Contact,
Name: !Jam,+t iu,C l.c%I�L�i�+� in, Phone: 9 Z-t-1V&s
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 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 =
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 _ = 6
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: C
PROCESSING FEE
CASH ❑CHECK ❑VISA ❑MC EXPIRES: $35.00
C4.
VIN: TOTAL PERMIT FEE DUE: ��
AUTHORIZED SIGNAT
REVISED 8/26/05 _