2004, 04-13 Permit App: BLD-04-04068 Lawn Sprinkler Received: 4/13/04 10:32AM; -> Haase Landscape Inc. ; Page 1
APR 13 2004 10:10 FR - TO 9260271 P.01/01
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ek., `1,„{ _ PLUMBING PERMIT APPLICATION
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Sale Or __ City of Spokane Valley Community Development Department
X I BulldingDivision
le 11707 E. Sprague Avenue, Suite 106
ySpokane Valley, WA 99206
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Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
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Project Address: 1 \ (0 1 S r ) Permit Use:
Phone (Daytime Contact): a 9 3.- -7 6`I
Owner: M ci.; ,�t� S lc. ( Yt )
Mailing Address: I 1 G I-5- E E. 3) {- S. `' .._,:t.A z V`"I'e NA/A State 9 zip code
City
Contractor: 14c.0-s Lc sem.c.-2-e. License#: Phone*: 9 z-v.. 7g5"--c)
Mailing Address: 2`t-O _-Z._ i` PO) a /A cI q z-0b
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST iu AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALSX $6.00
3 TUBSX 56.00
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6,00
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO.X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
6 GARBAGE DISPOSAL X $6.00
9 WATER SOFTENER �X $6.00 , _
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL I A $8.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X 58.00 =
CONDENSATE - --
12 ROOF DRAINS/OVERFLOW DRAINS X _ $6.00 =
13 FOUNTAINS,DRINKINGX $8.00 t=
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION.ALTERATION, X 56.00 =
VENT, PLUMBING,_REVERSAL REPAIR,REVERSALS -
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =A _
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D,FOR: X $6.00 = l9 0 0
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X 36.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00
20 MISCELLANEOUS PLUMBING FIXTURE X $0.00 v
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $36.00
DATE. EXPIRES: TOTAL PERMIT FEE DUE-
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: