2004, 10-14 Permit App: BLD-04-07923 Plumbing ReversalS .
40,017alley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuitdingDivision
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: 12-u/62.64-1
Project Address: 2(e -e_
Owner roe),
Mailing Address: Sin^
Phone (Daytime Contact):
Contractor: 5k4-( PCA..m hin-c
Mailing Address:
License #:
City
State Zip Code
Phone #: GI' Z2,- 16-1('(
City
State
BANKCARDNUMBER
AUTHORIZED SIGNATURE:
LF -1 477-
Zip Code
DESCRIPTION OF WORK
0 O
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET BIDETS
X
5600
=
2
URINALS -
X
$8.00
=
3
TUBS
-
X
58.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR
KITCHEN, LAUNDRY, UTILITY,
JANITOR PHOTO, X-RAY, FOOD,
PREP/CULINARY!MEAT
X
$6.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
58.00
=
6
GARBAGE DISPOSAL
X
58.00
=
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 DP-AIMS/OVERFLOW DRAINS
X
56.00
13
FOUNTAINS, DRINKING -
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTAL
RE R, EVERSALS
��
.1
X
56.00
l Go
(O
15
SEWAGE EJECTOR
GRINDER,
X
58.00
=
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.BP.D. FOR
VATS TANKS, BOILERS
X
_ 58.00
=
18
INTERCEPTORS
- GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT:'
ASH0 CHECK 0 VISA 0 MASTERCARD
DATE -0 EXPIRES:
SUBTOTAL
v - Q:
PROCESSINGFEE
535.00
TOTAL PERMIT FEE DUE:
4,l. 00
BANKCARDNUMBER
AUTHORIZED SIGNATURE:
LF -1 477-
Zip Code