2005, 08-25 Permit App: 05003106 Plumbing Fixtures ine PLUMBING PERMIT APPLICATION Community Development Department
r� ,\„ Building Division
Phone: (509) 688-0036; FAX: (50g') 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 ane Valley, WA 991206
do/Valley
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Project Address: ///3/a / _S— ./� A,P Permit Use:
-77'4Cam "-31 L' L.
Owner. /4,cJh ,. 5 /.�,"; ',4 Phone(Daytime Contact):
Mailing Address: / 5 57;"75- 4?74' E'
/ City State _Zip Code
Contractor. / /' . [� ,e- - ;;c) , License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST . = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 =
2 URINALS X $6.08 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT / X $6.00 =
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT if
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.0D =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.0D =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS I 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,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR VATS,TANKS,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 , =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 = .
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.D0 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑ CASH 0 CHECK ❑ VISA 0 MASTERCARD $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: