2007, 01-25 Permit App: 07000237 Plumbing Fixtures c Permit Center
�7` 1 11707E Sprague Ave,Suite 106
Nall Spokane Valley,WA 99206 PERMIT NUMBER: 1'v Z 3
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: C i
Community Development www,spokanevallev.ore J
Plumbing Permit Application ❑ Commercial �1! Residential
SITE ADDRESS: „5").5 aZ:) .)- 910)c12_11. q ),0
Building Owner--�0.f'lQS E -PQ��\S LC`LcL11
Name: _rteNCP Me c.k. Phone: ct3,tt
Fax: r?aLA
Address: Ci State: Zip:
15 aS 'E o ai°] ty' \a Q Y1 Q �� Q�'l
Contractor
QCt�tr t tlsciNur4r•
GEXIS1 V{ Irl Ace
Name: .. Phone: ,v4 Fax: t- ker
Address: tA n 1 City: -s noocei State: util. Zip:
License No: cayakti p A e.Z F N eatiQT City Busines$Lic:
Contact e(AGtuC1-0
Name: Phone: -3u�� \Sc-�(o�celt
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). tc,3ate\ BATH,STALL,ON-SITE 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 $6.00 =
10 ELECTRIC HOT WATER TANK 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
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05