2004, 10-22 Permit App: BLD-04-08003 Plumbing ReversalPLUMBING PERMIT APPLICATION
ShtY1(100000\0. City of Spokane tfa!fey Community Development Department
BuildingDivision
F� �%/1 ,......4,4,,„.;52 t 1707 E. Sprague Avenue, Suite f 06
def�e�% Spokane Valley, WA 99206
J
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: /0 X" 2 ,L,2i r,(, /
/s ,e) Permit Use:
Owner: /,Z) E./ -(z Phone (Daytime Contact):
Mailing Address: c,L yn .e 5 ,mkA.iiCity State Zip Code
Contractor. . / I ( 6, fu s / , AT,. License #:77c1e'� i771n6 Phone #: 5c'y- `/sr, --36 FT
Mailing Address:
DESCRIPTION OF WORK
*OF
UNITS
2
3
TOILETS
WATER CLOSET, BIDETS
. URINALS
TUBS
•
X COST
X $6.00
X $6.00
X $6.00
X $6.00
TOTAL
AMOUNT
5
SINKS LAVSIBASINS, BAR FLOOR
KITCHEN, LAUNDRY, UTILITY,
JANITOR PHOTO, X-RAY, FOOD,
PREPICULINARYYMEAT -
X
$6.00 =
.
6
DISHWASHER
X
$6.4
7
CLOTHES WASHER
X
96.00
_
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, X $6.00 111
CONDENSATE
12
ROOF DRAINS/OVERFLOW DRAINS X
56.00 =
13
FOUNTAINS, DRINKING X
$6.00
14
WATER PIPING/DRAIN-IN WASTE, INSTALLATION, ALTERATION, X
VENT, PLUMBING, REVERSAL REPAIR, REVERSALS
*6.00 = ep
r
15
SEWAGE EJECTOR GRINDER, SUMP PUMP
X
$6.00
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, ANDR.P.B.P.D. FOR
X
$6.00
VATS, TANKS, BOILERS
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00 il
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6:00 =
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00 =
METHOD OF PAYMENT:
❑ CASH
D CHECK
DATE:
❑ VISA ❑ MASTERCARD
EXPIRES:
BANKCARD NUMBER:
SUBTOTAL
PROCESSING fee
TOTAL PERMIT FEE DUE:
$35.00
AUTHORIZED SIGNATURE: