2006, 07-19 Permit App: 06002801 Plumbing Fixtures tro/,_ Permit Center
SFaia e*�"+ 11707 E Sprague Ave,Suite 106 PERMIT J ;,C 1
....*Valley Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037
Community Development wM1v.spokanevailzv_ors PERMIT FEE:
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Numbing Permit Application {1 Commercial esidential
SITE ADDRESS: 6=S`/ 9 e..--/C 7-
Building Owner
Name: Li it'Al -f eilki lar ie,f Phone: Fax:
Address: 6 67 i "c o %, Citys"pdtit iv,_0ilk State: tki 1,4. Tap:19 z. l
Contractor / I
Name: ` O %ft' rL e a r A!V.1,44• v✓ Ci Ph me j3 ''''co�` c 2.,_ Fax:
Address: Stf? t-7 s ,ko3 , ,44„-- City eace, i :e_ State: wii,
Zip: 990 2'Z
License No: City Business Lic: ! i a` i r C
Contact
Name kle, k 4I r-3,'0,.. Phone: 1-- 5/—670 q' H 6 -'ZOO- 31_</-e,
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 1 X $6.00 = Gj
2 URINALS , X $6.00 = ,
3 TUBS I X $6.00 = 6-,
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
LAVS/BASINS,BAR,FLOOR,KITCHEN.
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT (v
6 DISI-WASHER X $6.00 _
r
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 Vi LS REPAIR, '1
14 VENT,PLUMBING.REVERSAL R 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
DCASH 0 CHECK 0 VISA 0 MC EXPIRES: „$35.00
Card# VIN: TOTAL PERMIT FEE DUE: 9t
AUTHORIZED SIGNATURE:
REVISED 8126105
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