2004, 04-05 Permit App: BLD-04-03974 Plumbing ReversalS io'lanee
co#Ualley
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
Project Address: 6,...).(-1 3 /,y cc K, Roy Permit Use:
Owner:
Phone (Daytime Contact):
Mailing Address:
State Zip Code
Contractor: D,G,urLi
Mailing Address: Iq$Ib`i: Soraft, r
City
License #: Phone #: y`,5y 37/5r<
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE
iv1.F I.LTl1r-�
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56 00
=
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
5600
=
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
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$600
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION.
REPAIR, REVERSALS
gt
5600
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6.00
=
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
5600
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
56 00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES.
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE
iv1.F I.LTl1r-�
Zip Code