2005, 01-18 Permit App: 05000157 Plumbing Fixtures� PLUMBING PERMIT APPLICATION
�Phone: (509) 688-0036; FAX: (509) 688-0037
`YYtt�ll )u., For Inspections, Call (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
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Project Address: AU-) S 6: �t/� Permit Use:.
Owner: 1,78'TG-5 — 2/ (AG/jil✓(ole-CN Phone (Daytime Contact):,2o2F" / L/.%L
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Mailing Address: 5M9 -*-i
Contractor: /* 1312/c d qyp//t�
Mailing Address:
City State Zip Code
License #: O4n3,4q- Phone #: Q 7 (. 3.F3 J-
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City State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
0 OF UNITS
X
COST
-
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
1
X
56.00
2
URINALS
X
56 DO
3
TUBS
(
X
5600
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
1
X
5600
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO.
X-RAY, F000, PREP/CULINARY MEAT
X
56.00
6
DISHWASHER
X
56 DO
7
CLOTHES WASHER
X
$600
8
GARBAGE DISPOSAL
X
$600
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
5600
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
12
R00F,0RAINS/OVERFLO W
GRAINS
X
56 DO
13
FOUNTAINS, DRINKING
X
$6 00
14
WATER PIPING/DRAIN-IN WASTE,
VENT PLUMBING REVERSAL
NSTALLATION, ALTERATION, REPAIR.
REVERSALS
X
5600
15
SEWAGE EJECTOR
GRINDER. SUMP PUMP
X
56001
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR SWAMP COOLER
X
5600
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R P B P.D. FOR VATS, TANKS. BOILERS
X
86 00
10
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
5600
=
20
MISCELLANEOUS PLUMBING
FIXTURE -
X
58 00
21
PRIVATE SEWAGE OISPOSALJSYS
X
$2000
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
=
METHOD OF PAYMENT:
0 CAShH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE: /
q,m
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: