2008, 11-10 Permit App: 08004435 Plumbing Fixtures r qp
0/1111%,..... Permit Center -Spo �'C �� (-,-;7:("`r e 11703 E Sprague Ave,Suite B-3
Spokane Valley,WA 99206 PERMIT NUMBER:+�� (509)688-0036 FAX:(509)688-0037
Community Development permitcenter(ispokanevalley.org PERMIT FEE:
Plumbing Permit Application ❑ Commercial ❑ Residential
SITE ADDRESS: _ 11 9 6 /vdi
Building Owner
Name: /1 a f...../._�/ J .e�/ Phone: Fax:
Address: `/N/L/G aC he /I f�, City: S /�G/r tl LI /�` fr State: J r / Zip:
Contractor
J y/ J / `, / (•L/
Name: l L/7 in h lit/1 i r'Gt / Phone: ��(D` .....?e-Ko
Fax:
Address: �' I v /1.) i D1/_ J City: State: Zip:
License No: ism h'] E C i qq m/7 City Business Lic:
Contact pekti yt t /21 dd i-e. /
Name: Phone: ,6 _y 9c<3
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 = 6 civ
2 URINALS X $6.00 =
3 TUBS X $6.00 = 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 = VQ
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 WATER HEATER 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 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
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05