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2006, 10-26 Permit App 06004294 Plumb ReversalPermit Center *Wane `rane 11707 E Sprague Ave, Suite 106 jsValley Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevallev.orq Plumbing Permit Application n Commercial SITE ADDRESS: PERMIT NUMBER: '`'fa `t PERMIT FEE: ( c n Residential Building Owner Name: --7 U �� / i i v- C ,y Phone: Fax: Address: % 2 l� / L/ c �14/5'T/ 6i/v City: State: Zip: ContractorCo i/ ! NA /w - Name: Phone: Fax: Address: j 9 , / �,` City: State: Zip: License No: G v u A. cc /C 0 r /, 3/ 7 City Business Lic: Jk Contact l) 0t.. / two, no ,, , 9 E. 4/- c 1-/ 's .n...1 Name: Phone: i— DESCRIPTION OF WORK # OF UNITS COST TOTAL AMOUNT 1 2 TOILETS URINALS WATER CLOSET, BIDETS $6.00 $6.00 3 TUBS $6.00 4 5 6 SHOWERS PER TRAP SINKS DISHWASHER BATH, STALL, ON -SITE BUILT LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 0 $6.00 $6.00 $6.00 7 CLOTHES WASHER $6.00 8 GARBAGE DISPOSAL $6.00 9 WATER SOFTENER $6.00 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6.00 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE $6.00 12 ROOF DRAINS/OVERFLOW DRAINS $6.00 13 FOUNTAINS, DRINKING $6.00 14 15 16 17 18 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL SEWAGE EJECTOR WATER USING DEVICE CROSS CONNECTION DEVICE INTERCEPTORS 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 l $6.00 $6.00 $6.00 $6.00 $6.00 t6-0 0 19 20 MEDICAL GAS (per outlet) MISCELLANEOUS PLUMBING FIXTURE NITROUS, OXYGEN $6.00 $6.00 21 PRIVATE SEWAGE DISPOSAUSYS $20.00 22 INDUSTRIAL WASTE INTERCEPTOR $15.00 METHOD OF PAYMENT: CASH ❑ CHECK ❑ VISA ❑ MC / EXPIRES: / Card# / / AUTHORIZED SIGNATURE: REVISED 8/26/05 SUBTOTAL PROCESSING FEE TOTAL PERMIT FEE DUE: $35.00