2005, 11-10 Permit App: 05004259 Sink7'`` Permit Center
Spdkane 11707 E Sprague Ave, Suite 106
sl� Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www,spokanevalley.orc.com
Plumbing Permit Application
•
n Commercial
PERMIT NUMBER: 42 S
PERMIT FEE: ,Gt.
Residential
SITE ADDRESS:
Building owner
DESCRIPTION OF WORK
Name:u' St ) (4-Q,t,isnn
Phone: -C900•1-,-C9vy Fax:
Address: /V903 E gyet !d -r
City Li State: LL, Zip: 99w9j 7
Contractor
TOTAL AMOUNT
Name:
Phone: Fax:
,, /
Address: tS
City : State: Zip:
License No:
City Business License No:
Contact
Name: f/97-7---
Phone:
AUTHORIZED SIGNA
REVISED 8/26/05
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
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
/
/
X
$6.00
=
/...6'.9 C)
(�7
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
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
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
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
Card# , „ EXPIRES:
SUBTOTAL
('"
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
y/- 0-C
AUTHORIZED SIGNA
REVISED 8/26/05