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2004, 01-27 Permit App: BLD-04-03467 Plumbing ReversaldTF OF Y� . Spokane .I.ey PLUMBING PERMIT APPLICATION PROJECT ADDRESS: CI 9 2-] t t a1\._12—, DESCRIPTION PERMIT USE: OWNER: I.) V l i ,6.A....R.0 X PHONE (Daytime Contact): 9 2 2_ 3 3 0"7 MAILING ADDRESS: .5p,,,r�� AMOUNT (street) (city/state) S 0e., Z,,j a (zip) CONTRACTOR: t LICENSE* I C'.© uR tc. ] S i 1 D , ce_v t,C.,N. \z.A iNe� &t� = MAILING ADDRESS: 19 I8' E. sip Ua_ GRP :e.r, kP-es PHONE #: 507 clay_E Llgs tZa. 990 I z (street) (city/state) (zip) PLUMING FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BfDETS X $6 = 2 URINALS• X $6 = 3 TUBS X $6 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 = 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT X $6 6 DISHWASHER X $6 = 7 CLOTHES WASHER X $6 = 8 GARBAGE DISPOSAL X $6 = 9 WATER SOFTENER X $6 = 10 ELEC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL X $6 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 . _ 12 FOUNTAINS, DRINKING X $6 = 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS X $6 = 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 = 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, SUMPS, TANKS, BOILERS X $6 = 17 SPRINKLER SYSTEM X $25 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6 = 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 = 20 MISC PLUMBING FIXTURE X $6 = • - 1111111111111111: • •- ,w-:: SUBTOTAL • CASH • CHECK • MEM ■ __..__==: PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OFA MAJOR CREDIT CARD TOTAL PERMIT FEE DUE BANKCARD NUMBER: AUTHORIZED SIGNATURE: