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2008, 08-18 Permit App: 08003200 Cross Connect Device
,T�„ Permit Center Spokane 11703E Sprague Ave,Suite B-3 PERMIT NUMBER: j Z)30 Spokane Valley,WA 99206 jValleY (509)688-0036 FAX:(509)688-0037 PERMIT FEE: i/ ww w.spokanevallev.or� Community Development Plumbing Permit Application 9 n Commercial F2 Residential SITE ADDRESS: 10 ) q F- 4`t t- Building Owner Name: $ ✓vt S'k:A_Z G c.,f Cvt s Phone: 9 Z 6_, 3_ ---z 7 Fax: Address: /0 3 i E. q f-,.. A ac City: 5 pc<,,,,,,,,c State: >A tai Zip: 5,9 p 6Contractor I Name: gat-2.$L f S.C� Phone: q- 6, ...-i 7 S0 Fax: 9 Z 6 ©Z 7 ) C...,,\.Address: 1 L7.....0,t. Tp - V., City: seo,c4,n L State: LiA Zip: c 4 z(.9 License No: City Business Lic: Contact Name: %'Gt/,',,k_ _a0/A-C-5 Phone: 75?___5----s- 6/ — 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 = 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, i / 0 c> 17 CROSS CONNECTION DEVICE BOILERS 1 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 6 0 0 METHOD OF PAYMENT: PROCESSING FEE ❑CASH ❑CHECK ❑VISA 0 MC EXPIRES: $35.00 Card# VIN: TOTAL PERMIT FEE DUE: V/, )C) AUTHORIZED SIGNATURE: f7/('L- REVISED 8/26/05