2006, 04-07 Permit App: 06001235 Plumbing Fixtures •
-4"Permit Center
' 11707 E Sprague Ave,Suite 106 PERMIT NUMBER:
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
.--r,:mity Development wwwsookanevallev.ore "r"
.c'umbing Permit Application ❑ Commercial SResidential
SITE ADDRESS: I202(.9 G 154' OPnJE ViNne`c te.v\ 9`V2D1v
Building Owner 1/4..vir\k i
\‘A 14.)U ASS--Y1
Name: Phone: Fax• p!� L1 F� /
Address: `Zo06
c`�' City' }�[J�4Uc um, tate: ix\ Zip' ! to
Contractor 4kooe,_< �y
rine: Phone: Fax:
�0.{.\vYi.ic S (2,1,.\ p•', t i(Mr+wn�, 1� �y-1 - 119 —14-1- $507
dress: City: State: Zi
3tQ� � � AVE Sive�� LOP p 9°(2
0
2_,
L;cense No: c'o z (7 7 -S- City Business Lic:
Contact
Name: •_
\O, ' .n\)OA,a, V[.Il'-t2 Phone: 1 — 2cq— p•p 3F —
DESCRIPTION OF WORK *OF UNITS X COST ■ TOTAL AMOUNT
TOILETS WATER CL• ET s 3k i DETS 9C,
� 1 X $6.00
= i8
r- f // X $6.00 =
- ---- �'L7..� X $6.00 I ,�Y
=WRAP) BATH,ST• ,ON-SITE B' LT X $6.00 , = 17-
LAVS/BASIN',BAR,FLOOR,K • EN,
rt5 LAUNDRY ILITY,JANITOR,PH• 0,
5 X $6.00 = 3
X-RAY, -••D,PREP/CULINARY MEA
6 DISHWASHER X $6.00 = i 2--
7 CLOTHES WASHERX $6.00 =
sFr1 , j2
8 GARBAGE DISPOSAL 2 X $6.00 = t
9 WATER SOFTENER X $6.00 = Ite
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL I X $6.00 = , Le
AREA,CASE,COIL,TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAI 0 $6.00 =
' i3 FOUNTAINS,DRINKING X $6.00 = , -.--
WATER PIPING/DRAIN-IN W• TE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVER •L REVERSALS X $6.00 =
SEWAGE EJECTOR GRINDER,SUMP PUMP X 6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
S WATER USING DEVI. STEAMER X $6.r0 =
PROOFER,CARBONATOR,SWAMP ( } -,--
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 I CROSS CON CTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
.. ,_: . :.'iS CHEMICAL HOLDING TANK t X $6.00
_::)'CA' GAS(per outlet) NITROUS,OXYGEN p X $6.00 =
�a�;EOUS PLUMBING FIXTURE X $6.00 =
_ 1 PRIVATE SEWAGE DISPOSAL/SYS • 0 X $20.00 =
1 22 I INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT: I I y
PROCESSING FEE
CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Caro VIN: TOTAL PERMIT FEE DUE: a /z-1 '
AUTHORIZED SIGNATURE:
REVISED 8126/03