2005, 08-01 Permit App: 05002680 Sewer ReversalJUL 29 2005 15 04 FR
rLUTYIt 1NI, rtrcml I 1 IAJI'1
6:: KK 6;
pections, C
Phone: (509
Fo
TO 9284250 P.01/01
...A -pi 11,1,1}1 RLy ✓,/r „v, r•
Building Division
FAX: (509) 688-0037 ,� ,11707 E. pokane Valley, WArague Avenue, u1te 106
99206
11 (509) 688-0054 (t :r �,�5`
Permit Use: S&zI /' ver.s-a-e
Project Address: / % /l
Owner. -a es, d
Mailing Address: /PM t dc52P/2
S
Phone (Daytime Contact): f956 Sa1
Gr/ 2//
Zip Code
Contractor 4 /9,0/1//1/424/ PJUryi h any 6i License #:A!i vANPL+9 4Phone # _2S-6///
City State
Mailing Address: PO 9/6 r ?9,01'
City State zip Code
BANKCARD NUMBER: -
AUTHORIZED SIGNATURE:
** TOTAL PAGE.01 **
DESCRIPTION OF WORK
1 OF UNITS
X
COST .
36.00
e
=
TOTAL AMOUNT
1
TOILETS
_
WATER CLOSET, BIDETS
X
2
URINALS
X
56.00
0
3
TUBS
X
58.00
•
4
SHOWERS (PER TRAP),
BATH, STALL, ONSITE BUILT
X
38.00
0
5
SINKS
LAVS/BASINS. BAR FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANrrOR, PHOTO,
X.RAY, FOOD, PREP/CULINARY MEAT
X
56.00
=
B
DISHWASHER
-
X
56.00
0
7
CLOTHES WASHER-
X
36.00
=
B
GARBAGE DISPOSAL
X
56.00
-
9
WATER SOFTENNS=R
-
X
56.00
•
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.0D
0
11
FLOOR DRAINS
AREA,CASELCOIL, TRENCH, CONDENSATE
X
56.D0
0
12
ROOF DRAINSIOVERFLOW
DRAINS
X
36.0D
•
13
FOUNTAINS, DRINKING
X
36.E
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLA • , _-' T'• . , REPAIR,
R - LS -
%
!
X
Sem
=
6; L"?
15
SEWAGE EJECTOR
GRN. - - -- - PUMP
X
56.00
61
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER. CARBONATOR, SWAMP COOLER
X
36.00
_
17
GROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK VALVE,
AND R.P.B.P.D. FOR VATS. TANKS, BOILERS
x
S6_D0
=
1 B
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
X
56.06
=
19
MEDIAL GAS (per outlet
NITROUSLOXYGEN
X
56.00
20
_
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
•
21
PRA/ATE SEWAGE DISPOSAUSYS -
X
520-00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315-00
=
METHOD OF PAYMENT:
❑ CASH O CHECK
DATE
0 VISA 0 MASTERCARD
SUBTOTAL
PROCESSING FEE
335.00
1
EXPIRE$:
TOTAL pf]iJlfr FEE DUE:
Cr
C1. / � • .
BANKCARD NUMBER: -
AUTHORIZED SIGNATURE:
** TOTAL PAGE.01 **