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