2005, 04-04 Permit App: 05001063 Plumbing ReversalPLUMBING PERMIT APPLICATION
ne� Phone: (509) 688-0036; FN(:11.509) 688-0037
{YLd For Inspections, Call (509) 688-0054
Project Address: /ljr( / it AZA/e)
Owner 0 7H, X(141? -56 /S/A/
Mailing Address:
Contractor:7
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
lsa/g f, g th(da p4Atn l �
City17-21 Ceile
ate
City State
X90 3_
Zip Code
Phone #:
% 9/4
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
p OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY. JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
56.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
5600
=
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
56.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
13
FOUNTAINS. DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION,.ALTERATION, REPAIR,
LI REVERSALS
/
X
56.00
=
�
l! -/C
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:
0 CASH 0 CHECK
DATE:
0 VISA 0 MASTERCARD
SUBTOTAL
PROCESSING FEE
5355..000
EXPIRES:
TOTAL PERMIT FEE DUE:
el/ r / (/
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: