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Permit App: BD03-485 Plumbing Reversal
LETHOD OF ] CASH 'ATE: Spokane ems"°` #valley Plumbing Permit Application 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call 509-688-0054 . PROJECT / ADDRESS' �rJJo/f S7VGd _A DESCRIPTION PERMIT USE: �Ufez,5 f / OWNER /J / ' r G -c, / �( X PHONE (Daytime Contact): MAILING ADDRESS:il-f.......004....e."-c. /01'0 F iv (A .a CPaC� (street) ty/state) (ZIP) CON7-RACTOR: l ,/ 5",-. LICENSE 1/:.A."�C C 4% 09601)-✓ MAILING ADDRESS: 37v�e----2- $ - 1119-01-1 10.--eat-7 .9r',wl'c - PHONE 1: ) D -2/8 /x% �� .575'7 2 7 /74, (street) (city/state) (ZIP) PLUMBING FIXTURES ANKCARD NUMBER UTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 - 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 • 5 SINKS LAVS/BASINS, BAR, FLOOR KITCHEN, LAUNDRY, UTILITY, JANITOR PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 - 6 DISHWASHER X - 7 CLOTHES WASHER X • 56 - B GARBAGE DISPOSAL X - 9 WATER SOFTENER X - 10 ELECT. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X 56 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X 56 - 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING. REVERSAL INAALLAPI N, ALTERATION, REPAIR, X - f 6 REVERSALS 14 SEWAGE EJECTOR GRINDER SUMP PUMP X •- 15 WATER USING DEVICE ICE SWAMP AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, COOLER X $6 • - 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND RP.B.P.D. FOR: VATS, TANKS, BOILERS X 86 - 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE HOLDING TRAP, SAND TRAP, CHEMICAL TANK X - 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 - 20 MISC. PLUMBING FIXTURE X $6 - PAYMENT• CHECK MUM ' RL'RSF._4 SUBTOTAL: PLUS PROCESSING FEE: $35.00 0 itLigni ■ rvororc. TOTAL PERMIT FEE DUE: /:„.7f ANKCARD NUMBER UTHORIZED SIGNATURE: