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2004, 06-24 Permit App: BLD-04-04707 Plumbing ReversalMETHOD OF ❑ CASH DATE: San r 11707 East Spra�ue Avenue, Suite 106 509-688-0036 - Phone �kaile Spokane Valley, WA 99206 509-688-0037 - Fax Walley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT ADDRESS: 1 / i . ofI JI ) / PERMIT USE: DETAILS OWNER: ) / , 7 / / 1- p4 l� l / T PHONE (Daytime Contact): r7 /. COST MAILING ADDRESS: . 33�'0 /��� 6�MMa lJt S-/ (street) (city/state) • (ZIP) ,9, COCTFR: a p I urn {� 1 %1C ? /Ll LICENSE A: X MAILING ADDRESS: / 3C -//a S.dcic�n� 1 q PHONE P: /� i _ S / I / 2 URINALS (street) (city/state) (ZIP) PLUMBING FIXTURES BANKCARD NUMBER: AUTHORIZED SIGNATURE- DESCRIPTION • DETAILS # OFUNITS X COST EQUALS AMOUNT 1 TOILETS - WATER CLOSET, BIDETS X 66 - 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 5 SINKS LAYS/BASINS, BAR FLOOR KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 6 DISHWASHER X $6 . - 7 CLOTHES WASHER . X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X . $6 - 10 ELECT. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X $6 - 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING. REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS / X $6 - - 14 SEWAGE EJECTOR GRINDER SUMP PUMP X $6 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 - 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X S6 17 SPRINKLER SYSTEM X 625 - 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 66 - 19 MEDICAL GAS per outlet - NITROUS, OXYGEN X $6 - 20 MISC. PLUMBING FIXTURE X $6 - PAYMENT CHECK Y/S4' SUBTOTAL: PLUS PROCESSING FEE: $35.00 ■ 0 _`e,:'".r_ TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE-