2006, 12-11 Permit App: 06004595 Plumbing ReversalSpokan'� a `�
..0,0Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite
Spokane Valley, WA 99206 I I
(509)688-0036 FAX: (509)688'003/
ww w. spokan ev al l e v. ore
Plumbing Permit Application
SITE ADDRESS:
5
-- NOV 2 0
Commercial
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PERMIT NUMBER: el5 95'
PERMIT FEE:
idential
Building Owner
Phone:
Fax:
Name: Q t r-7/7.1_
7,7A
Address: 76' 1� S�e.
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City:
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State:
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Zip:
Contractor
Name: Co C/ v c /� / 6
Phone:
Fax:
Address:
City:
State:
Zip:
License at)rz cc r�i it No:
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City Business Lic:
Contact
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Name: LA) 6. I AZ— l Ail Are- G'%� / �.�Y
Phone: Q z /!i
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DESCRIPTION OF WORK
# OF UNITS X
COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
X
$6.00
2
URINALS
X
$6.00
3
TUBS
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
5
SINKS
LAVS/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
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
de. o d
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
X
$6.00
17
18
19
20
21
22
CROSS CONNECTION DEVICE
INTERCEPTORS
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING FIXTURE
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE INTERCEPTOR
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS,
BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
METHOD OF PAYMENT:
❑CASH ❑ CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
X
X
X
X
X
X
$6.00
$6.00
$6.00
$6.00
$20.00
$15.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
$35.00
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