2005, 02-16 Permit App: 05000501 Plumbing ReversalPLUMBING PERMIT APPLICATION Community Development Department
Building Division
OC Phone: (509) 688-0036; FAX: (.509) 688-0037 11707 E. Sprague Avenue, Suite 106
galley For Inspections, CaII (509) 688-0054 Spokane Valley, WA 99206
�CCx( ha c), N6 bW
I 3 2a 41.31,1„1/4„2_) Permit Use: 1- UceSiA1,.
Project Address:(�b pp�
Owner: 0< •4. }''%o
Mailing Address: D0 dO01( iy( 3So7
Contractor:
Mailing Address'
Phone (Daytime Contact): 9 a2' 7S6 c%
Sae�o�n.
City
License #:
r4 rA 9921y
State Zip Code
Phone #:
City
State
, Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
$ e
DESCRIPTION OF WORK
NOF UNITS
X
COST •
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS'
X
56.00
=
2
URINALS
X
56.00
3
TUBS
X
5600
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
5600
7
CLOTHES WASHER
X
56 00
8
GARBAGE DISPOSAL
X
56 00
=
9
WATER SOFTENER
X
5600
=
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
56 00
=
•
13
FOUNTAINS, DRINKING
X
56 00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
t
X
56.00
=
00
ll
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 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
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES:
SUBTOTAL
G, OO
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
/ '
U.I,
. o
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
$ e