2005, 04-26 Permit App: 05001342 Plumbing ReversalPLUMBING PERMIT APPLIeCATION Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707.E. Sprague Avenue, Suite 106
For Inspections, CaII 19) 688-0054 Spokane Valley, WA 99206
at; 7ite)nye
Permit Use:
Phone (Daytime Contact):
Project Address: .3
Owner. Yr74—
Mailing Address:
®5u./3y?
AState Zip Code
Contractor 77 C-7 47A, s ,,,,./,-rbtj_icense #: Phone #:
Mai ing Address:
City
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
0 OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
36.00
=
4
SHOWERS (PER TRAP)
BATH STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
36.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
36.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
36.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR
REVERSALS
/
X
36.00
=
//''
(j2 00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
18
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR SWAMP COOLER
X
36.00
-
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
36.00
=
21
PRIVATE SEWAGE DISPOSAVSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
0 VISA 0 MASTERCARD
SUBTOTAL
(, , to
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
-fy9
- / ef3Q
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: