2005, 04-08 Permit App: 05001128 ROW, Plumbing Fixtures, Reversal1
1ETHOD OF
CASH
tATE,'
.00fr
Valley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For In.pectItons, call 509-688-0054
Plumbing Permit Application
PROJECT
ADDRESS: /4/3
OWNER: hi '1,4' 14)
MAILING ADDRESS:
PERMIT
USE:
PHONE (Daytime Contact):
a71 -31q9-3
(Street) (city/state)
(ZIP)
CONTRACTOR: 014,
C-Oh-c-t-Y/LC-t1 Di%)
MAILING ADDRESS:
LICENSE
PHONE
1/ gi 7 e Dc,( ley Lacy
•k)0 kart -
(street)
(city/state)
.4(
0(z, q9,z9
(Llf) •
PLUMBING FIXTURES
EXPIRES:
ANKCARD NUMBER
UTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
56
-
2
URINALS
X
$6
-
3
TUBS
X
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON -St I e, BUILT
/
X
$6
-
ae)
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
i
X
56
-
6,Do
6
DISHWASHER
X
$6
-
7
CLOTHESWASHER
X
-
8
GARBAGE DISPOSAL
X
s6
-
9
WATER SOF 1 hNER
X
56
-
10
ELECT HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56
..
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56
-
12
FOUNTAINS, DRINKING
X
56
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMB:NG
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56
-
.".
‘'0
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR.
SWAMP COOLER
X
56
-,
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
-.
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK .
X
$6
••
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FDCTURE
X
$6
-,
PAYMENT
D CHECK
' , :.---r.•
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
11 '
0 0
TOTAL PERMIT FEE DUE:
/-719
EXPIRES:
ANKCARD NUMBER
UTHORIZED SIGNATURE:
Cod 2lhoars baikso mipoctia ixogoiiod
Pboao509.b88.OQ36 Fax 509.615-0037
65- //2g1
• Anticipated start date Permit # PW
ROW CONSTRUCTION
Lcation of property /e /.3) 4t zIAA/� /.
• (Adda/Partel #r If available)
Applicant Name 772�4#J ,9
Address Phone
Contractor's Name H4- 3 & 3Ar Sf y ixd -L.0 n
Address // J? 17 g Vaiiirkt, Phone q�A291#
comer. RliiiMaaires
PROJECT DES CBIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ❑ Driveway
cu.& Goner
fl G
Other
Pavement Cat? Dinseasions
beonMewb►the
Pormitme Signature Approved
l booby arrihodzetreaty ofSpolemeVaMitDdais S Ise tort* peeibwoodland.
Coedit EspkaliooDda
Nuns of Haider SbneR�se
Fees Pald$
(Application) (Inspection)
In addition to the penult application fee of $16.00 or $25.00, Inspection on each pennit WA be
biped to the permittee ata rate of OO per hour vatra $26.00 (112 hour) mh*nwu. Pemitlee
eianatwe on pem>et ccneiNutss an agreement to these temw and provisions.
tuft
Work completed satisfactorily (Signed) Date
00 • .......--.ui /Nal litioNtiffoettinam Tinkdrit 11 entered bar