2005, 01-27 Permit App: 05000261 Addition, Plumbing Fixtures PLUMBING PERMIT APPLICATION1 Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
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Project Address: //t/0 t' ®/" Permit Use:
Owner: _.9— Al _ 'Z£,' ? _ Phone (Daytime Contact): gol` 7fi' 9/3/
Mailing Address: //6/® G• //r-.' de re -Oat/ ail 9,i5.6
City State Zip Code
Contractor: p yr/_. /vfi. License #: Phone#:
Mailing Address: /SG/o .F - /0'1
City State Zip Code
DESCRIPTION OF WORK N OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS I X $6.00 /
= (� --0
2 URINALS X $6 00 =
3 TUBS X $6 00 =
G/ - ud
4 SHOWERS(PER TRAP) TALL,ON-SITE BUILT I X $6 00 =
• LAVS/BASINS BAR, FLOOR, KITCHEN,
5 SINKS Y,UTILITY.JANITOR,PHOTO, X $6.00 = ..o
X-RAY,FOOD,PREP/CULINARY MEAT 7' I -
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 l X $6.00 = t •020
11 FLOOR DRAINS AREA, ASE,COIL,TRENCH,CONDENSATE I X $6 00 = L .v
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 RPB 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 00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL o p
METHOD OF PAYMENT: .3'L
PROCESSING FEE
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: 7/ •oD
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: