2004, 03-12 Permit App: BLD-04-03750 Plumbing Fixtures PLUMBING PERMIT APPLICATION
SCR OF a City of Spokane Valley Community Development Department
BuildingDivision
galley 11707 E. Sprague Avenue, Suite 106
do, Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: '_ 6 7 I 5 g ( k Permit Use:
Owner: ' k4 el, 3.e rUC&+i Lk'D Phone (Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: A A-D 4 Esc > U 4`- 24,,i *> License#: ? AV i4,0/1626C-Phone#: `3(2-c -6( ( (
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS WATER CLOSET,BIDETS 1 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 LAYS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD, t
PREP/CULINARY/MEAT t .
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,
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: 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
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
h)'I
DATE: EXPIRES: TOTAL PERMIT FEE DUE: _ 6°
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: