2005, 05-16 Permit Application: 05001589 Plumbing ReversalProject Address: // 9 // //hi
Owner:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688- 0036; Fax: (509) 688 -0037
FOR INSPECTIONS, CALL (509) 688 -0054
Permit Use:
% % Phone (Daytime Contact): ?, -)/ -6 c /)5
Mailing Address: %/ 9 /e( F • a ,e. ' ' (, . wv � 7 )G
��'p City
Contractor: 6,pLk topp/Ltyrtheefol License #: c /� -P_
Mailing Address: :3 c_ % a S , dli(iiax 5 o 4 ,,hp fit) f 99 (),�
I City
State Zip Code
Phone #: 9'c /-5—W 3
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
*OF
UNITS
X
COST
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ONSrE BUILT
X
56.00
=
5
SINKS
LAVS /BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILRY,
JANITOR, PHOTO, X -RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
X
56.00
6
DISHWASHER
7
CLOTHES WASHER
X
56.00
i
e
GARBAGE DISPOSAL
X
56.00
=
X
56.00
9
WATER SOFTENER
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
X
$6.00
=
12
ROOF DRAINS /OVERFLOW DRAINS
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, RATION,
REPAIR,(REVI<RSALS
X
56.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
16
WATER USING DEVICE
ICE AN /OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
56.00
=
X
$6.00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P- B.P.D- FOR
VATS, TANKS, BOILERS
X
56.00
=
16
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
, 20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
.
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
j -7
/� /) i)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code