2005, 05-25 Permit App 05001780 Plumbing FixturesPLUMBING PERMIT APPLICATION
OC Phone: (509) 688-0036; FAX: (509) 688-0037
/Valle, For Inspections, Call (509) 688-0054
Project Address: •2410) c6i4_,D&LJ Y /
Owner: U t /C i rnm e n,l) Phone (Daytime Contact):
Mailing Address:
Contractor: JC %Y? c , /
Mailing Address: 331d / s( fJ- t
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
I ')
Permit Use:
City State 7 Zip Code
License #: / 'i inFe_A"q4/inPhone #: 2 -" 3 2`''3
City State Zip Code
D
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
2
URINALS
X
$5.00
=
3
TUBS
/
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
rl
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
/
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
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, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
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
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
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
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
S35.00
TOTAL PERMIT FEE DUE:
/ -
S r e 0-
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: