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2005, 09-02 Permit App 05003245 Backflow Preventerspo�an .Valley Permit Center 11707 E Sprague Ave, Suite 106 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevallev.org.com Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: o Commercial o Residential SITE ADDRESS %D Building owner Name: JQSC pit . R T o R tEL L Li Phone: (500 9_26 -935( Fax 9a_.6 451 Address: /0 y i S E , IACity Spr, I(i4. VA -US,/ State (,4111— Zip 994 6 Contractor n(,;) AJ-EP, Name: Phone: Fax: Address: City State Zip License No: City Business License No: Contact Name: Phone: DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6.00 = 2 URINALS • X $6.00 = 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 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 I'C 1LOL PRk1%Etir ER I X $6.00 = f �� 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = , METHOD OF PAYMENT: / CASH XCHECK - •# SUBTOTAL 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: / I ., 00 AUTHORIZED SIGNATURE: REVISED 8/26/05