2003, 05-07 Permib: BD03-363 Plumbing Reversal, FixturesMAY -07-03 WED 10:39 AM R
FlU �fL"h ADDRESS
PLUMBING PERMIT APPLICATION
5099283474 P.02
bo o3"35
4
`
11k \'[IIY�� 1(� A \ (Qh 4 PHONE DAYTIME CONTACT p �R -- Jy
V191I.I\Li ADDRESS 4' d,0 ‘4.\\I s DS)
e k;\f a. °I � 03
(Strut) (city / state) I ZIP)
r)NIRi('I'()R: \1V'AG C��Strv.<-. 0YM LICENSE. V)st`LCC -1 Iqa`-
PHONE C\'�—C}
(nty tate
SI Alt ING 11DDRESS
(Suter)
Yt-LI �r3
(LIP)
a
PLUMBING FIXTURES
#OF
UNITS
MULTIPCOST/U
UED
NIT
TOTALS
AMOUN I
H(1_y
TUI ITS
WATER CLOSETS, BIDETS
/
x
x
S 6
S 6
=
S k
S
H04
URINALS
/304
'111111
BATH, JACUZZI, SPA, GARDEN
x
S 6
S
1301
BIT
4
SI IU\1'I,I< (per trop)
BASE, STALL, ON-SITE BUILD
/
x
$ 6
r
S b
SI W.4
LAYS/BASINS. BAR. FLOOR,
KITCHEN, LAUNDRY, UTILITY, /
JANITOR. PHOTO, X-RAY, FOOD
(PREP/CU UN ARY/MEAT)
x
E b
S
10
807
150d
111111WAS1'II'Rx
E 6
S
t'i.0 11HI:S WASHER
x
S 6
S
1109
(I1f(ILACI'i DISPOSAL/GRINDER
x
1 6
S
HID
1311
Rrr
B 13
HI+
)}11)
H16
re'r,
lrlT"
\VI I LR SDI -TUNER
x
S 6
S
I -,F( 'TRI(' HO f WATER TANKS
(NO rE) t gas voice, unk, see inechaic.)
x
S 6
5
fl ()OR hR\INA
AREA. CASE. COIL, TRENCH,
CONDENSATE
x
S 6
$
RI nP DRAINS/OVERFLOW DRAINS
x
$ 6
S
FO1INT,AINS/DRINKING
z
S 6
S
Ls'. I C-R PIPING/DRAIN.WASrE-VEN
1'1 I IMBINC RLVERSAI S
INSTALLATION, ALTERATIONSI
REPAIR, REVERSALS
x
S 6
S
LP
SI 1GE EJECTORS
GRINDER, SUMP PUMP
K
$ 6
S
'\\ A 11:0. USING DEVICES
ICE AND/OR COFFEE MAKER,
HOSE BIB. STEAMER, PROOFER
CARRONATOR, SWAMP COOLERS
x
S 6
S
(ii),,, -fl NNCC-110 DE .bs
VACUUM BREAKER, CHECK VALVE,
ANDR P B P.D. FOR -VATS.
SUMPS, TANKS, BOILERS, &
SPRINKLER SYSTEMS
x
5 6
S
[310
SY
H'1
IN I I,I4C1.11' ORS
GREASETRAP, SAND TRAP,
CHEMICAL HOLDING TANK
x
S 6
S
.
.1Ih.DI('AL GAS (per outlet/bottle nation)
NITROUS, OXYGEN
x
S 6
j/ '
MI M_LLLANEO1IS FIX'T URES
x
5 6
/
V
NOTE: MINIMUM PERMIT FEE IS $35.00
E- ESIDENTIAL I l COMMERCIAL
,IGNATURE: Ci\
1pt .4r„ C °wary Division of Bul!ding & Planning
1016 W Woadwsy An:nuc • Spokane. WI. 99260
(509) 456.3675 • Fax No (509) 524.3198 • TDD Nu (509) 324.3166
gnkauc t 'natty Ate. MA Antrum/we on the Sam of d4tblllty m tic .d, ,:non to, or treatment Sr <mph. [Star ,n, ,t. program. or attIvinc..
Subtotal
PLUS: PROCESSING FfE
\I
TOTAL PERMIT FEE DUE\
DO
25.00
$ I}q a 0 (0
PLEASE MAKE CHECKS PAE TO
SPOKANE COUNTY PERMIT CE T
MAY 04 2003 10:34
PAGE.02