2004, 10-29 Permit App: BLD-04-08067 Plumbing ReversalSri(la e
T 61-x/ P/vim^ 5‘-eS r'2o / ., r ft --".
Project Address: V//
Owner: / P,ni4 —co 4'1.,o
Mailing Address:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildiingDivrsion
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:
Contractor.
Mailing Address:
Phone (Daytime Contact):
SQMH Spn inn, co (S 72�--_3l,
C ty State Zip Code
74 277:747-3:,License #: 77/i y t,,i Phone #:
-3a? a?
%Gio/ aC74i)ey /City O Fte 9POd
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS X COST =
TOTAL
AMOUNT '
1
TOILETS
WATER CLOSET, BIDETS
X - - 56.00
t 2
URINALS
X $6.00 =-
-
3
TUBS
-
X 56.00 =
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X 56.00 =
5
SINKS
LAVSIBASINS, BAR, FLOOR
KITCHEN, LAUNDRY, UTILITY, '
JANITOR PHOTO, X-RAY, FOOD,
PREP(CULINARYIMEAT •
' X 56.00
-
6
DISHWASHER
X 56.00
7
CLOTHES WASHER
X 56.00 =
8
GARBAGE DISPOSAL -
X $8.00 = •
9
WATER SOFTENER
X 56.00 =
10
ELECTRIC HOT WATER TANK
NOTE IF GAS SEE MECHANICAL
X 56.00 - _
11
FLOOR DRAINS
'AREA, CASE, COIL, TRENCH,
CONDENSATE
X 56.00
12
ROOF DRAINS/OVERFLOW DRAINS
X $8.00 =
13
FOUNTAINS, DRINKING -
- X 56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,(r
REPAIR, REVERSALS
X 58.00 =
th. W
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 =
17
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK '
X $8.00
VALVE, AND RPBP.D. FOR:
VATS, TANKS, BOILERS
18
INTERCEPTORS
- GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X $6.00 '
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X -
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
- -
X
56.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES: -
SUBTOTAL
PROCESSING FEE,535..00
TOTAL PERMITTEE DUE:'
e:// r co
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: