2008, 05-13 Permit App: 08001624 Plumbing Fixtures\ Permit Center
S" - ne 11703 E Sprague Ave, Suite B-3
.,,;,OOValley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development �)kjnevallev.or«
Plumbing Permit Application ❑ Commercial
SITE ADDRESS: L- 2-<0-
PERMIT NUMBER:
PERMIT FEE:
idential
Building Owner
DESCRIPTION OF WORK
Name:
Phone:
Fax:
Address: i
City:
State: Zip:
Contractor
WATER CLOSET, BIDETS
Name:
Phone:
Fax:
Address: Z LA
City: S ,/--CL
State: /�/� Zip: C�G� 1 I
c7
License No:
City Business Y-ic:
X
Contact
=
Name:
Phone:
REVERSALS
12
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
NSTALLATION, ALTERATION, REPAIR,
X
$6.00
=
3
TUBS
REVERSALS
X
$6.00
=
4
SHOWERS PER TRAP
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAYS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
STEAMER
X
$6.00
=
7
CLOTHES WASHER
PROOFER, CARBONATOR, SWAMP
X
$6.00
=
8
GARBAGE DISPOSAL
COOLER
X
$6.00
=
9
WATER SOFTENER
VACUUM BREAKER, CHECK VALVE,
X
$6.00
-
10
ELECTRIC WATER HEATER
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
1 ROOF DRAINS/OVERFLOW DRAINS
X
1 $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 DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
=
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
[]CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05