2005, 06-28 Permit App: 05002217 Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For I spections, CaII (509) *88-0054
Project Address: ` % / /() RA. �Q eel Permit Use:
Owner.
Mailing Ad:ress:
Contractor. —h/ C
City
License #: Phone #:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Dayt/) me Contact):,�
1AA
,Op 14� Vit/�
// State Zip Code
Mailing Address -
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
$6.00
=
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
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
56.00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
56.00
=
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 DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.0D
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATON, ALTERATION, REPAIR
REVERSALS
/
X
36.00
=
//
1C_!9 Q
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
35.00
=
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
36.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520 00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
SUBTOTAL.
�9/ r 00
0 VISA ❑ MASTERCARD
PROCESSING FEE
535.00
EXPIRES: -
TOTAL PERMIT FEE DUE:
—Ig 4/11' en
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: