2005, 01-10 Permit App: 05000087 Plumbing ReversalPLUMBING PERMIT APPLICATION Communityroeveldpmrk-
LIDepartment
Building Division
Re Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
'Valley For Inspections, Call (509) 688-0054 45S -Spokane Valley, WA 99206
Project Address:
Owner: 4_9/Yp q to
Mailing Address: ✓j�
Contractor: ,E eestar,
rir,
Permit Use:
Phone (Daytime Contact):
City
License #:
State Zip Code
Phone #:
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
N 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
LAYS/BASINS. BAR, FLOOR. KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA. CASE. COIL, TRENCH. CONDENSATE
X
$6 00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
131
FOUNTAINS. DRINKING
X
$6.00
/)
14
\WATER PIPING/DRAIN-IN WASTE,
NT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR.
REVERSALS
X
$6.00
=
�iS
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6 DO
=
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
$6.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
X
$6.00
$6.00
r.
20
MISCELLANEOUS PLUMBING
FUTURE
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$1500
METHOD OF PAYMENT:
❑ CASH CHECK
DATE. / .--. /
SUBTOTAL
5 VISA ❑ MASTERCARD
PROCESSING FEE
$35.00
EXPIRES.
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: