2005, 08-09 Permit App 05002825 Plumbing FixturesPLUMBINERMIT APPLICATION
Phone: (509) 688-0036; FAX: t509) 688-0037
For Inspections, Call (509) 688-0054
Project Address: 5W1--/ E. ae-e2✓hp,Gv
Owner. 2 E, /Z
Mailing Address: J/4 . 1,r1Di4- 4
IlD mmunity Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
Zip Code
Contractor. z,N, OE �te4M License #: $ :18.2� . 010 Phone #: '2)47 -'ige - 1-6,( O
Mailing Address:
1
2
City State
10Z-c Ll,ES'r ! A.&' A. � r-n�)C
City
DESCRIPTION OF WORK
TOILETS
URINALS
WATER CLOSET, BIDETS
L�1 Ar
State
Zip Code
# OF UNITS X COST
I? X $6.0D
3
4
5
6
7
8
9
10
11
12
TUBS
SHOWERS PER TRAP
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW
DRAINS
13
14
15
16
17
16
19
20
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
CROSS CONNECTION DEVICE
INTERCEPTORS
MEDICAL GAS (per outlet'
MISCELLANEOUS PLUMBING
FIXTURE
21
22
PRIVATE SEWAGE DISPOSAUSYS
INDUSTRIAL WASTE
INTERCEPTOR
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
DATE
BANKCARD NUMBER:
BATH STALL, ON -SITE BUILT
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILnY, JANITOR, PHOTO,
X-RAY FOOD, PREP/CULINARY MEAT
NOTE IF GAS SEE MECHANICAL
AREA, CASE, COIL, TRENCH CONDENSATE
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS OXYGEN
X $6.00
X
$6.0D
oZ X $6.00
/0
0
X
TOTAL AMOUNT
$6.0D
$6.00
X $6.00
X $6.00
46 X $6.00
Q19-5 X $6.00
G, X $6.00
' X $6.00
X $6.0D
3
45
X 36.00
X $6.00
X
X $6.00
64'
$6.00
X $6.00
X $6.00
X $6.00
2°'
X $20.00
X $15.00
❑ VISA
EXPIRES:
0 MASTERCARD
SUBTOTAL
PROCESSING FEE
02
$35.00
TOTAL PERMIT FEE DUE:
10/
AUTHORIZED SIGNATURE:
Project Number: 05002825 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
gate: 8/9/2005 Page 1 of 2
Permit Use: 16 PLUMBING FIXTURES
Setbacks: Front Left:
Site Information:
Plat Key:
Right: Rear:
Contact: INLAND EMPIRE RESIDENTIAL RESO
Address: 116 W INDIANA AVE
C - S - Z: SPOKANE, WA 99205
Phone: (509) 789-2245
Group Name:
Project Name:
Name: HUTCHINSONS ADD
District: Nort
Parcel Number: 45183.0127 Block:
SiteAddress: 8120 E BROADWAY AVE
Location:: CSV
Zoning: UR-3.5
Urban Residential 3.5
Water District: 005 HUTCHINSON
Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 60
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Lot:
Owner: Name: INLAND EMPIRE RESIDENTIAL R
Address: 116 W INDIANA AVE
SPOKANE, WA 99205
Hold: ❑
Review
Plan Review
Permits:
Contractor: UNKNOWN
Address: UNKNOWN
UNKNOWN, WA UNKNOWN
Item Description
TOILETSBIDETS
SINKS
SHOWERS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
FLOOR DRAINS
WATER USING DEVICES
PROCESSING FEE
Plumbing Permit
Firm: UNKNOWN
Phone: (000)
Units Unit Desc
2 NUMBER OF
4 NUMBER OF
2 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
2 NUMBER OF
3 NUMBER OF
1 SELECT
Permit Total Fees:
000-0000
Fee Amount
$12.00
$24.00
$12.00
$6.00
$6.00
$6.00
$12.00
$18.00
$35.00
$131.00
Operator: DMD
Printed By: DMD Print Date:
8/9/2005
Project Number: 05002825
• 'Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes
Payment Summary:
Permit Type
Plumbing Permit
Inv: 1
Fee Amount
$131.00
$131.00
Invoice Amount
$131.00
$131.00
'ate: 8/9/2005 Page 2 of 2
Amount Paid Amount Owing
$0.00 $131.00
$0.00 $131.00
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: DMD Printed By: DMD Print Date: 8/9/2005