2006, 01-05 Permit App: 06000033 Sewer Reversaleassr.‘4... Permit Center
Spokane 11707 E Sprague Ave, Suite 106 ,
Walley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.snokancrallev.ore com
Plumbing Permit Application
PERMIT NUMBER: 0033
PERMIT FEE:
❑ Commercial ❑ Residential
SITE ADDRESS:
Building owner
5 ,A P fPTY'Te rt
# OF UNITS
Name:
COST
=
/./
Phone:
Fax:
Address:
7
0 9 J'/
/311 es c A &
City. State:
Zip:
' Contractor
7-A, C. .
$6.00
=
Name:
TUBS
x
Phone:
Fax:
Address:
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
City : State:
Zip:
License No:
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
City Business License No:
X
Contact '.
t-
6
DISHWASHER
- '
Name:
$6 00
=
7
Phone:
AUTHORIZED SIGNATURE:
REVISED 826/05
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
x
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56 00
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6 00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS. SEE MECHANICAL
X
5600
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
S6 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
/ D
15
SEWAGE EJECTOR
GRINDER. SUMP PUMP
X
$6.00
=
n
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
5600
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS. BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
320.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card#
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
di I DO
AUTHORIZED SIGNATURE:
REVISED 826/05