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2005, 03-17 Permit App: 05000805 Plumbing ReversalProject Address: Owner: A,o Mailing Address: PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 6 J 2°7 L. Cr9t- let, 4.e Permit Use: Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 >a N49 fro -c 017 Phone (Daytime Contact): Contractor: 744.,/1-y Mailing Address: City • License #: State Zip Code Phone #: • City State Zip Code BANKCARD NUMBER AUTHORIZED SIGNATURE: DESCRIPTION OF WORK *OF UNITS X . COST ' _ 'TOTAL AMOUNT 1 TOILETS - WATER CLOSET. BIDETS - X ' $6.00. _ 2 URINALS X $6.00 - 3 TUBS - '-"' X $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ONSITE BUILT ' . X $6.00 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, -LAUNDRY. UTILITY, JANITOR, PHOTO, X-RAY, FOOD, .PREP/CULINARY MEAT X 56.00 = 6 DISHWASHER _ _ X' 56.00 = 7 CLOTHES WASHER X 5600 = 8 GARBAGE DISPOSAL - - . X 56.00 9 WATER SOFTENER X 16.00 = 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 E6.00 13 FOUNTAINS, DRINKING - X 56.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, . REVERSALS % X ' 56.00 . = c , m U 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X. 56.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR SWAMP COOLER X 56.00 . _ 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 - FIXTURE X 56.00 21 PRIVATE SEWAGE DISPOSAL/SYS . X 520.00 = 22 INDUSTRIAL WASTE . INTERCEPTOR - X• 515.00 = METHOD OF PAYMENT: ' ❑ CASH 0 CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL PROCESSING FEE .535.00 . TOTAL PERMIT FEE DUE: BANKCARD NUMBER AUTHORIZED SIGNATURE: