2004, 12-07 Permit App: 04009345 Plumbing Reversal, FixturesPLUMBING PERMIT APPLICATION
� Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
�C� 32 or J,1.. ed`fexion1Gen
Project Address: I
Owner: /40 ov-er" / +a rvt c --
Mailing Address: 33:rf ,& .
Contractor:
mw 67(6,0,4,7,5-
Mailing
7((aw,tw.s
Mailing Address: yb?7 Jc' n_ /Lot
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
93 21S -
Permit Use: pt....kx'vta
Phone (Daytime Contact):
cure key) Az_
City
License #:
City
Nnh 9 $ 31
State Zip Code
Phone #:
gy
Zip ode
C."141 -
State
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK -
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
56.00
=
/
(, `/IW
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSXTE BUILT
1
X
56 00
=
// OD
l9- W
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
FOOD, PREP/CULINARY MEAT
/
X
56.00
=
ll..ii
�i1 coX-RAY,
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
5600
9
WATER SOFTENER
X
5600
=
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
5600
=
14
WATER PIPING/DRAIN-IN WASTE.
VENT. PLUMBING, REVERSAL
NSTALLATION,:ALTERATION, REPAIR,
( REVERSALS%
1
X
5600
=
' ( TUO
15
SEWAGE EJECTOR
GRINDER'SUMP PUMP
X
5600
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
5600
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
52000
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
(') l
"(r v OD
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
S-6)7:00DATE:
/ : W
BANKCARD NUMBER
AUTHORIZED SIGNATURE: