2004, 08-30 Permit App: BLD-04-07515 Plumbing ReversalSp°"lan• e3/4
Valley
- 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):
��City F St
Ity State
Zip Code
License #: Phone #: 2 -t/—R<ssa
Project Address: 3D3 , hr S, i
Owner 54,-,
Mailing Address:
Contractor. Au -1i t-/ieaiAd79
Mailing Address: 3-7Z/ /1 /72/ 7d
5aok9 -i e2
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
S`iuti
Zip Code
DESCRIPTION OF WORK
SOF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
58.00
=
2
URINALS
X
56.00
=
3
TUBS
X
58.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
=
5
SINKS
i
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
6
DISHWASHER
X
56.00
=-
7
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
58.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS -
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
58.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
58 00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
)e-
X
56.00
=
15
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 RP.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
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES.
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
S`iuti
Zip Code