2005, 07-14 Permit App: 05002390 Plumbing ReversalPLUMBING PERMIT APPLICATION Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
&-.5-40/(iy) Nos- 61s.,2,0
Project Address: 3if:, j . Sik° t`Cg Permit Use:
Owner. /, di e 5 LE -IF G.T Phone (Daytime Contact):
Mailing Address: l pCr, F a'vi�ir i-6...,Co% ice , 7?o ??
City State Zip Code
Contractor. %? C ( _sZ c 2'± _, , License #:
Phone it: YSC - Rs '?
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
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL ONSITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
86.00
=
6
DISHWASHER
X
86.00
=
7
CLOTHES WASHER
X
$6.OD
=
8
GARBAGE DISPOSAL
X
$6.OD
=
9
WATER SOFTENER
X
$5.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
S6.OD
=
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.D0
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR
REVERSALS
/
X
$6.00
=
/�
(p . CO
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.DD
=
16
WATER USING DEVICE
ICE AWOR 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
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.0D
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
820.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
SUBTOTAL
6.00
0 VISA 0 MASTERCARD
PROCESSING FEE
$$35.OD
EXPIRES:
TOTAL PERMIT FEE DUE:
7l, 0 O
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: