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2005, 04-04 Permit App: 05001062 Plumbing Reversal
et' 4,14Hey PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 Q6mmunity Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 19-?, Project Address: 9/' ,/,PSS , %S'J? LfIi • Permit Use: SE2rAo / z/F PSA�- Owner. R 6E/ r g1� 7- Phone (Daytime Contact): , co7. SI - Mailing Address: . L5/7E /9s A?�i ig Skaq.` City License #: Contractor. S _F Mailing Address: 4yt� • • •4/,ob'e' State Zip Code Phone #: Zip Code City State BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK * OF UNITS X . COST • = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS' X ' $6.00 . = 2 URINALSX $6.00 = 3 TUBS X 56.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ONSITE BUILT ' . X $6.00 = 5 •LAVS/BASINS, SINKS BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD,.PREP/CULINARY MEAT X $6.00 = 6 DISHWASHER X 56.00 = 7 CLOTHES WASHER , X 56.00 = 8 GARBAGE DISPOSAL " . X $6.00 = 9 WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X 56.00 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6.00 = 12 'ROOF DRAINS/OVERFLOW DRAINS X 56.00 = 13 FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, • REVERSALS ICO X 56.00 = \Y " 10o 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6.00 = i 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 56.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 56.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X 56.00 _• _ 20 MISCELLANEOUS PLUMBING• FIXTUREX 56.00 = • 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X 515.00 = • METHOD OF PAYMENT: ❑ CASH 0 CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL l:J\ O O PROCESSING FEE ..535.00 TOTAL PERMIT FEE DUE: vl 1. 00 BANKCARD NUMBER: AUTHORIZED SIGNATURE: