2006, 06-13 Permit App: 06002293 Plumbing Fixtures Permit Center
Sf oka le 11707 E Sprague Ave,Suite 106
Valley PERMIT NUMBER:
Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037
' CommunityDevelopment ��w.spokanevallev.ors PERMIT FEE:
Plumbing Permit Application (l Commercial ❑ Residential�
SITE ADDRESS: /V Cr/ � teN `J 6/-)44e-e �A-/(47, 0./A -
Building Owner 7
Name: p r`� l G V c 43
d �i U Phone:a-749 c;
7 // Fax:
Address: ` g, E.. o U� City: d e (/ K. State: 1-4.M— Zip: /7 7 3?
Contractor 5^P a- 5 -G lJ T v
Name: Phone: �,I /4//f-- Fax: /
Address: ---742 /t)/ ina/�`1 / City'�Po
r State: Zip: 1 e So
License No: 6 S r ' �y City B ess Lic:
o'tBQ Le City
,coots e< rc✓�i,c(f\ '
Name: Phone: 0
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 ON-SITE BUILT f 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 DISPOSAL/SYS 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 5126/05