2006, 10-02 Permit App: 06003913 Plumbing FixturesPermit Center
Spokane 11707 E Sprague Ave, Suite 106
��Valley Spokane Valley, WA 99206 PERMIT NUMBER:
(509)688-0036 FAX: (509)688-0037
Community Development atic yspokan.eyallk�y,org PERMIT FEE:
Plumbing Permit Application ❑ Commercial Rhes/idential
SITE ADDRESS: t'I7 S Ave J%7[j/C:Q�E' ISAi_Lt ?Zd6
Building OwnerRE Nl Y Am de &
ATE o
Name:
Phone: S� �J'� c�Z Z�� .� Fax:
Address:S E ' lI`
City:�� tate: �� Zip: 41.7 LOEi
Contractor
TOTAL AMOUNT
Name:
Phone: Fax:
Address:
City: State: Zip:
License No:
City Business Lic:
Contact
Name: A—A 13 e, /Z 'A -re N - L a
Phone: �'o y _ •� rp . 3.7 / y
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
LAVS/BASINS, BAR, FLOOR, KITCHEN,
5
SINKS
LAUNDRY, UTILITY, JANITOR, PHOTO,
X
$6.00
=
X-RAY, FOOD, PREP/CULINARY MEAT
(JU
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
-
DD
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 ❑ CHECK ❑ VISA ❑ MC EXPIRES: t3�A9--
Cerd# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05