2005, 04-27 Permit App: 05001349 Plumbing ReversalProject Addr ss.
Owner:
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0054
/505 6- 4v475t-
Li,
Awe
Mailing Address
Contractor:Z-
Mailing Address
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
6-
Permit Use: J / Cif
Phone (Daytime Contact):
/s -)s- s. J-O'y/"tet siptrit/it /xfd. 9zr to
City State Zip Code
License #: 071 V/i /e Phone #:
/l 0) 4 75710/2
Zip Code
y
City
State
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
11 OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
56 00
=
2
URINALS
X
56 00
=
3
TUBS
X
5600
=
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
5600
=
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
56 00
=
14
WATER
PLUMBING,ASTE,
VENT, PLREVERSALPIPING/DRAIN-IN
NSTAL�TIOREVERSALS' N, REPAIR,
N. Q
/
X
5600
=
`��
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
5600
=
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
55 00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56 00
=
21
PRIVATE SEWAGE DISPOSAIJSYS
X
520 00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE.
0 VISA 0 MASTERCARD
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES
TOTAL PERMIT FEE DUE:
G/ I. (? \ /
BANKCARD NUMBER.
AUTHORIZED SIGNATURE: