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2009, 03-11 Permit App: 09000581 Plumbing Fixtures t • X%` Permit Center '\ "" 11703 E Sprague Ave,Suite B-3 L n �' / PERMIT NUMBER: .00.0Valley Spokane Valley,WA 99206 (509)688-0036 FAX:(509)688-0037 �J PERMIT FEE: Community Development permitcenter@spokanevalley.org Plumbing Permit Application n Commercial HrResidential SITE ADDRESS: _ (U)D S (T' � LC � V..J illi,. Building Owner Name: Phone: Fax: �II.�.>z� ���,� ��y�s� - ye Address: `0 .0,..,; S Dc7 1 4. SI.s City: Se 0 Cl) UCSc;,)State: kdOct.D k . Zip: Contractor \_ Name: e,a".�1yA- ►,,1w\b;1J 1/411 Phone: Fax: Address: ' to kC1 Z\0.-,aki-wel CALks IC. 00(- City: ...)t.0 T e ,c' State: k..,),:s,ij\‘._ Zip:C)C. l,S(4 License No: (5 j me` --I 3 zu City Business Lic: Contact vv 1 V 3T q (; g /� ( ,� g Name: 1. . i Q 2JJjQ' �` �ci�O�JPhone: CLezr✓ C uvc. C�C�`-f.–2QJ( f — DESCRIPTI•N OF WORK �J #OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6.00 = Le 2 URINALS X $6.00 = 3 TUBS I X $6.00 = (-49- 4 -P4 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 Z l D-- 6 DISHWASHER X $6.00 = 7 CLOTHES WASHER f X $6.00 = 8 GARBAGE DISPOSAL l 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 O METHOD OF PAYMENT: PROCESSING FEE OCASH ❑CHECK ❑VISA ❑MC EXPIRES: $35.00 Card# VIN: TOTAL PERMIT FEE DUE: t•CSC) AUTHORIZED SIGNATURE: - -----2--- -----__ REVISED 8/26/05