2005, 03-01 Permit App: 05000595 Remodel `I PLUMBING PERMIT APPLICATION Community Development Department
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Dr ft Building Division
,APhone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
di/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: ,.),3 , /5 Perit Use:
Owner: i ///[,'® Jilt CvT G/Wn? Phone (Daytime Contact):
Mailing Address: S'vyj
City State Zip Code
Contractor: ��L y'S PZE;Q#bt_i.r ; a License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X .COST• = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6.00
2 URINALS X $6.00 =
3 TUBS _. X $6.00 _ =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT / X $6.00 =
• LAVS/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 _1 $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
_ 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE _ X $6.00 =
ROOF DRAINS/OVERFLOW
12 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 BREAXER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,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 • =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSALJSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
0 CASH 0 CHECK 0 VISA 0 MASTERCARD .$35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: