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2008, 09-02 Permit App: 08003435 Plumbing Fixtures
s Permit Center 11703 E Sprague Ave, Suite B-3 �, &i. mI a PERMIT NUMBER: s Spokane Valley, WA 99206 ,/`ILY (509)688-0036 FAX: (509)688-0037 PERMIT FEE: Community Development permiteenter cgspokanevalley.org Plumbing Permit Application ❑ Commercial Residential SITE ADDRESS: / V �12 S F 27 try/T (/e Building Owner DESCRIPTION OF WORK Name: eQ 5- Phone: 8�� _ 2� Fax: Address: /0 2 5 f 2 !f✓�X e City. © a4eVallev State: W11 Zip: � O,?7 Contractor Name: F� G Phone: -O� Fax: Address: 511 City: j State: �� Zip: �IJQ 7 L� e' O //t License No: T C �r%oC� 7 J ��1 City Business Lic: Contact $6.00 = Name: ,-11, Phone: AUTHORIZED SIGNATURE: REVISED 8/26/05 DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 2 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 = LAVS/BASINS, BAR, FLOOR, KITCHEN, 5 SINKS LAUNDRY, UTILITY, JANITOR, PHOTO, % X $6.00 = ,Q X-RAY, FOOD, PREP/CULINARY MEAT 6 DISHWASHER X $6.00 = CJ 7 CLOTHES WASHER / X $6.00 = 8 GARBAGE DISPOSAL X $6.00 = 9 WATER SOFTENER X $6.00 = 10 ELECTRIC WATER HEATER 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 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER / X $6.00 = / PROOFER, CARBONATOR, SWAMP b/ 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 ❑ CHECK ❑ VISA ❑ MC EXPIRES: $35.00 TOTAL PERMIT FEE DUE: to T 04 Card# VIN: AUTHORIZED SIGNATURE: REVISED 8/26/05