2004, 04-26 Permit App: BLD-04-04194 Plumbing ReversalMETHOD OF
❑ CASH
DATE:
Spokanetoogis`
Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT ^^�� ��{{ %//�J ��/'`
ADDRESS:
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PERMIT
USE:
OWNER: L 6
9 c.p yyoC1f(0n
f„ !r
PHONE (Daytime Contact):9 d "1 __:34,/
MAILING ADDRESS:
(street) (city/state) (Z2))
EQUALS
n,
CO RA,CTTR: t/11a /r/ ^ ? I ( kms,) 4>;- no,
-LICENSE
p:
WATER CLOSET, BIDETS
MAILING ADDRESS:
3 c/ i S. dalx C
X
/'3
PHONE #: a / '
l
S ! q / 3
2
(street) (city/state) (ZIP)
PLUMBING FIXTURES
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
86
2
URINALS
X
$6
-
3
TUBS
X
$6
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
-
5
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, VRLITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
-
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL(
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
86
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER HOSE BB,
STEAMER, ?ROOFER, CARBONATOR,
SWAMP COOLER
X
$6 -
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet -
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
86
is
PAYMENT
❑ CHECK
VISA
US
_-._ ^_,'�
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
■ ❑
TOTAL PERMIT FEE DUE:
/
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BANKCARD NUMBER
AUTHORIZED SIGNATURE: