2004, 05-14 Permit App: BLD-04-04353 Plumbing ReversalValley
Project Address:
Owner: t
rn 1e9,
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
., FOR INSPECTIONS, CALL (509) 688-0054
/. 1� Permit Use:
h.ne (Daytime Contact): 1-
MT 5 X12
City State Zip Code
Mailing Address: I `Y3 fb"&-QJ „o
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Contractor:
License #:
Phone #:
Mailing Address:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
-
X
$6.00
=
2
URINALS
X
56.00
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56 00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56 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
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
Il.rl, I CIO
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE 81B, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D- FOR:
VATS TANKS, BOILERS
X
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
METHOD OF PAYMENT:
❑ CASH D CHECK 0 VISA 0 MASTERCARD
DATE' EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: