2005, 07-20 Permit App: 05002456 Plumbing Reversal, ToiletPLUMBING PERMIT APPLICATION
L
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
Project Address:. /5.Z/G 2 Ciz e/ado
Owner ceR2 y .�%u�n. e
Mailing Address: (/ Son ti
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact):
Contractor. TAC
Mailing Address. q e 0` S Ain 0 T 4,QaC
City
License #:
State Zip Code
Phone #:
C`t.enGy
City t/
bjel
State
9 940
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
-
R OF UNITS
X
COST .
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
56.0D
=
C
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
=
_
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, U IUTY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
56.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
B
GARBAGE DISPOSAL
X
56.09
=
9
WATER SOFTENER
X
55.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE COIL TRENCH, CONDENSATE
X
56.0D
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
-
14
WATER PIPING/DRAIN-IN WASTE
VENT, PLUMBING, REVERSAL
NSTAUATION, ALTERATION, REPAIR
REVERSALS
X
56.00
=
/
h
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.03
=
18
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
NrrROUS, OXYGEN
X
56.00.
=
20
MISCELLANEOUS PLUMBING
FIXTURE
-
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT: -
�
SH 0 CHECK
DATE
SUBTOTAL
- 0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
97
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: