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2007, 03-19 Permit App: 07000834 Sewer
Permit Center SOMCane 11707 E Sprague Ave, Suite 106 ,4,000Va11ey Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.snokanevallev.orz Plumbing Permit Application ❑ Commercial SITE ADDRESS: ! 2- S Cs E, 36) PERMIT NUMBER: PERMIT FEE: Residential Building Owner DESCRIPTION OF WORK BOILERS # OF UNITS X Name: E% e n = Phone: 5"0t, _ gy Z- 3 8 7 y Fax: 1 TOILETS Address: / LSO S E 3 0 t -A City State: w4 Zip: cf 9 Z / Z Contractor 2 URINALS CHEMICAL HOLDING TANK Name: X Phone: 2 c� g- )?2- 3 C �l / Fax: -2- Address: Address: / l� 1 �/. City. %- H d State: _ Zip: 1�7 3 5' S License No: R L90p i 0'r City Business ic: b 6 S O D 4 Contact BATH, STALL, ON-SITE BUILT X $6.00 Name: ! Phone: Z e'5, LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 17 1 DESCRIPTION OF WORK BOILERS # OF UNITS X COST = TOTAL AMOUNT 1 1 TOILETS WATER CLOSET, BIDETS X $6.00 = 2 URINALS CHEMICAL HOLDING TANK X $6.00 = 3 TUBS NITROUS, OXYGEN 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 DISHWASHER X $6.00 = 7 CLOTHES WASHER SUBTOTAL METHOD OF PAYMENT: X $6.00 - 8 GARBAGE DISPOSAL EXPIRES: $35.00 X $6.00 = AUTHORIZED SIGNATURE: 9 WATER SOFTENER REVISED 8/26/05 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, ALTERATIOW,REPAIR REVERSALS X $6.00 - 6 ©C) 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 = VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, 17 1 CROSS CONNECTION DEVICE BOILERS X 1 $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 DISPOSAL/SYS X $20.00 = F221 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