2007, 05-23 Permit App: 07001946 Plumbing Fixtures � Permit Center
�n.rn�a�•� 11707 E Sprague Ave,Suite 106
�Va1le3' Spokane Valley,WA 99206 PERMIT NUMBER:
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokanevallev.org
Plumbing Permit Application ❑ Commercial TA Residential
SITE ADDRESS: _ f 5 2 �( r (' 4
Building Owner -L..),j a 6-re `e
Name: - Phone: C L Fax:
L)c,J l t 1> lel/`�
Address: f L `•! c /e, C l� City: 5-in KI ._c JA,1 State: i,.,L)4 Zip: JC' 7
Contractor
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact
Name: `-00.,_,..3 "- �: Phone: i'el C, __ 1 k`l�y G/ / % c--t % -//
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00 = C..)
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I 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 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 DISPOSAL/SYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT: L y _ U v
PROCESSING FEE
['CASH ❑CHECK ❑VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE: > q.. U C
AUTHORIZED SIGNATURE: �' /
C..____
REVISED 8/26/05
r