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2007, 05-17 Permit App: 07001832 Cross Connect Permit Center poka-he 11707E Sprague Ave,Suite 106 .Valley Spokane Valley,WA 99206 PERMIT NUMBER: i / .0. (509)688-0036 FAX:(509)688-0037 --t PERMIT FEE: 44 I------- Community Development www.spokanevallev.ore ` Plumbing Permit Application ❑ Commercial Residential SITE ADDRESS: J (/Q J /Z ril 4V-1.-- Building -- Building Owner Name: • ,,./, „-i, v4 j Phone: Fax: Address: !2/rrz. J t /1 jh City: State: Zip: Contractor 7 Name: Phone: Fax: Address: City: State: Zip: License No: City Business Lic: Contact f l?.i tAji Elft.. Name: Phone: G-0?,z i1,c•—�� cic DESCRIPTION OF WORK l #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, 17 CROSS CONNECTION DEVaTh BOILERS X 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 ❑CASH ❑CHECK ❑VISA 0 MC EXPIRES: $35.00 Card# VIN: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05