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2004, 11-16 Permit App: BLD-04-08135 Plumbing Reversal
PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Project Address: O, /.1. el t.„,_ /7, t�,i— - Permit Use: Owner: 1/yr 4- Phone (Daytime Contact): Mailing Address: ,C. / ,'T /L /21-_,c---•-, i....2-- C nc � -Nh- GJ/A- State Zip Code Contractor: y --4.•, _ L= . �d , License #:,“//12G'E1 r9/9% Phone #: ,-Q/' --,2e57 / J / Mailing Address: ,E /0 ?7-3 /A— — 2 o,C� City ity State Zip Code BANKCARD NUMBER: , AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST- = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X 36.00 = 2 URINALS X $6.00 = 3 TUBS - X $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X 56.00 = 5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT X 36.00 = 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 ORAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS, DRINKING X $6.00WATER 14 WASTE, VENT, PLUMBING REN-INVERSAL NSTALLATIOREVERSALS ALTERATION, REPAIR, / X 36.00 _ A 9 G 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X 36.00 = 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, AND R.P.B.P.D. FOR: VATS, TANKS BOILERS X $6.00 = 18 INTERCEPTORS ' GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X 36.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSALBYS X 520.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X 515.00 = METHOD OF PAYMENT: �{ - ❑ CASH CHECK 0 VISA 0 MASTERCARD P DATE: // - /4 - O EXPIRES: SUBTOTAL n / (Y l7 PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: t_( (• 6° BANKCARD NUMBER: , AUTHORIZED SIGNATURE: