2005, 03-03 Permit App: 05000625 Plumbing FixturesPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address: % 09 6 f 9
Owner:
S -122 -
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
Mailing Address:
City State Zip Code
r4UC4T5 N SnW PLOTIM61iJiL License #1✓R'o& IlDgg 373 Phone #: Q7 'f'- fee/
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City
Contractor:
Mailing Address:
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
R OF UNITS
X
. COST •
-
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS'
/
X
' 56.00
2
URINALS
X
56.00
=
3
TUBS '"
1
X
16.00
=
j!
0
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
'LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
/
X
56,00
6
DISHWASHER
I
X
56.00
rp
CLOTHES WASHER
1
X
56.00
=
COL
6
GARBAGE DISPOSAL
X
56.00
=
4
WATER SOFTENER
X
56.00
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
1
X
56.00
=
6
11
FLOOR GRAINS
AREA, CASE. COIL. TRENCH CONDENSATE
X
58,04
=
12
'ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
55.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT PLUMBING REVERSAL
NSTALLATION, ALTERATION, REPAIR
. REVERSALS
X
56.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP .
X
56.00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
12
X
56,00
=
��
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS BOILERS
X
35.00
=
16
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING
FURURE
X
56.00
21
PRIVATE SEWAGE DISPosAusYs
X
520,00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH HECK 0 VISA 0 MASTERCARD
DATE EXPIRES:
SUBTOTAL
148.00
PROCESSING FEE
.535.00
TOTAL PERMIT FEE DUE:
f)"3 .0O
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: