2005, 02-28 Permit App: 05000580 Drain, Piping . c3---__ 5-g 6,
PLUMBING PERMIT APPLICATION Community Development Department
.,�n Building Division
ine
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
do/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: (p9 0� E. lo ` Permit Use:
Owner: VA,a_ i„�e- •J-c,w`5 Phone (Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: (l u,i1iu- ,ro k..Lb,M, Mf_ --' License#: 1A1UE:L4.-'x8(o c !„Phone#: /9 3 (07 7/
Mailing Address: 3 G z_g E, 3 Z.
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS' X $6.00 =
2 URINALS X $6.00 =
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
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER j X $6.00 =
•
10 ELECTRIC HOT WATER TANK _ NOTE: IF GAS,SEE MECHANICAL _ X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE I X $6.00 =
'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 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 FIXTUREX $6.00 = •
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 = _
SUBTOTAL
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE .$35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER: h 41/2
AUTHORIZED SIGNATURE: Ai L---1...- _..„-----&,-)