2004, 06-15 Permit App: BLD-04-04611 Plumbing ReversalMETHOD OF
❑ CASH
DATE:
Same
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT 6c_toniiiiPERMIT
ADDRESS: O0C�ji
(C�-PHONE
'J
USE:
DETAILS
# OF UNITS
OWNER: JI Cy i
rtiL� if �/
(i
(Daytime Contact): q _,5-s--- -43--
3'
MAILING•1
MAILING(A_DDRESS:
a'-ri. 6
AMOUNT
(street)
(city/state)
(ZIP)
COI�I�iZA Q/rck_ ? / l
t (
n i n6M
LICENSE #:
2
MAILING ADDRESS:((R:
3c -/lc S.daa
PHONE #:
•
�0�1-5
�/ �
-
3
(street)
(city/state)
(ZIP)
,
PLUMBING FIXTURES
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
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
ELECT. 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, TANKS, BOILERS
X
$6
''
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$b
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIX'T'URE
X
$6
=
PAYMENT
❑ CHECK
SA
e''Vzf i
_=
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
■
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: