2005, 03-15 Permit App: 05000771 Plumbing Fixtures PLUMBING PERMIT APPLICAT!;7N Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
,Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: I 6-e S7 1. I Vii) <_ Permit Use:
• Owner: J 0 Itir► 14-E,'4aer-r— Phone (Daytime Contact):
Mailing Address: I l SO' 6 .
City State Zip Code
Contractor: j �ib [ • 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 = k'j� e'rk
2 URINALS X $6.00 =
•
3 TUBS X $6.00 = �
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT ' . X $6.00 = :�- `G/
• LAVS/BASINS,BAR,FLOOR,KITCHEN,
•
5 SINKS 'LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,.PREP/CULINARY MEAT C3C)
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 HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 =
'ROOF DRAINS/OV.ERFLOW
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 BREAKER,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 DISPOSAL/SYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 = •
SUBTOTAL
METHOD OF PAYMENT: •
0 CASH 0 CHECKVISA 0 MASTERCARD PROCESSING FEE .$35.00
• DATE: EXPIRES: TOTAL PERMIT FEE DUE:
•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: •