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