2006, 10-11 Permit App: 06004080 Plumbing Fixtures Permit Center
Spokane11707 E Sprague Ave,Suite 106
PERMIT NUMBER:. ' ne Spokane all ,WA 99206. O�
y (509)688-0036 FAX:(509)688-0037 PERMIT FEE: ,S
Community Development www.spokanevalley.or2
Plumbing Permit Application ❑ Commercial residential
SITE ADDRESS: ‘5// .( /
7'4—
Building Owner
Name: /---) ,_/ Phone: Fax:
Address: City: State: Zip:
Contractor -A e
cer
Name: f ` Phone: Fax:
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Address: el 0c' 5 f✓,A `Pep(It City: G 4--P,r7.eiy State: >A) Zip: 61 aDLi
License No: City Business Lic: vvvl
Contact
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 = b
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 =
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:
PROCESSING FEE
IDeASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: �.7.
REVISED 8/26/05