2006, 04-12 Permit App: 06001311 Plumbing ReversalPermit Center
Spo"kaenye 11707 E Sprague Ave, Suite 106
YQlley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688;0037
Community Development ..1vw spokanevalle)• ory
PERMIT NUMBER:/5i%
PERMIT FEE: Y/
Plumbing Permit Application n Commercial Residential
SITE ADDRESS:
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Building Owner
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Name:
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Phone:
Fax:
Address:30 1ha
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State:
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Contractor _
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Name: _OvJa / /lel. c-rxrc,A+G ✓/v_
Phone:
Fax:
Address: ye/
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State:
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License No: co u Q cc /8/ /C ?
City Business Lic:
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Name:
Phone: z/6_ /6 9./7
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
X
56.00
3
TUBS
X
58.00
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
56.00
6
DISHWASHER
X
56.00
7
CLOTHES WASHER
X
58.00
8
GARBAGE DISPOSAL
X
56.00
9
WATER SOFTENER
X
56.00
10
• ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
12
ROOF DRAINS/OVERFLOW DRAINS
$6.00
13
FOUNTAINS, DRINKING
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
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
$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
56.00
19
MEDICAL GAS (per outlet)
NITROUS, 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:
❑CASH D CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
AUTHORIZED SIGNATURE: -
REVISED 8/26/05
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
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