2006, 07-31 Permit App: 06002939 Plumbing Fixtures�� Permit Center
,opokane 11707 E Sprague Ave, Suite 106
Valley Spokane Valley, WA 99206 PERMIT NUMBER: 0_D1�(
(509)688-0036 FAX: (509)688-0037 n
Community Development www.spokanevallev.org PERMIT FEE: '): ` )
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Plumbing Permit Application n Commercial Residential
SITE ADDRESS: 3
L
Building Owner
DESCRIPTION OF WORK
Name:
Phone:
Fax:
Address:_
City: r�
State: Zip:
Contractor
WATER CLOSET, BIDETS
Name: LPhone:
$6.00
Fax:
Address:
City:
State: Zip:
License No: < 121
City Business Lie:
X
Contact
=
Name:
Phone:
AUTHORIZED SIGNATURE
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
I COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
Q
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
=
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
-
METHOD OF PAYMENT:
SUBTOTAL
❑CASH ❑CHECK El VISA El MC
MC EXPIRES:
FEE
$35.00
TOTAL PERMIT FEE DUE:
�7 ,c9e.;'
Card# VIN:
AUTHORIZED SIGNATURE
REVISED 8/26/05