2004, 09-02 Permit App: BLD-04-07551 Cross ConnectAPR 13 2004 10:10 FR
Mffley
TO 9260271 P.01/01
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BulldingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTION-, CALL (509) 688-0054
Project Address: Li 9 0 3 E- Z 9 Permit Use:
Owner: ) o'^^- e_Lo I-)-zv. S Phone (Daytime Contact):
Mailing Address: / `19 0 3 T . ZLJh" Sim" j< 0,lA e- v`.,) i `7 LA -)A 9 q ! 7
City State Zlp Code
License #: i4ct LI o`11. Phone*: 91-- 6, - 7 crs O
P-- Co Wts 99 --o Co
State Zip Code
Contractor: PacA 5�
G v,-) (c
Mailing Address: C 1 ZZ V Z , c -pe Rd sr r•c" c_
City
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
NOF
UNITS
X
COST
■
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
36.00
2
URINALS
X
36.00
a
3
TUBS
X
36,00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6,00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY.
JANITOR. PHOTO. X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
X
$6,00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
38.00
r-
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
58.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
• 13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN•IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION. ALTERATION,
REPAIR, REVERSALS
X
56.00
=
13
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
36.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER.
CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D, FOR:
VATS, TANKS, BOILERS
X
38.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK ❑ VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
536,00
TOTAL PERMIT FEE DUE:
, 1 LA)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: