2005, 07-27 Permit App: 05002617 Sewer ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (Z09) 688-0037
For Inspections, Cali (509) 688-0054 D
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Project Address: (�
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
aCL \-1 Spokane Valley, WA 99206
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Owner. / v, P(,-vv,r-.61Q/,, Phone (Daytime Contact): I t *----C/6.2 6
150 Yl . 4-41-y..r L )ft
City State Zip Code
License #: Phone #:.53,a--i/763--
(44444401
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F 44444 1 j orvouQ 04 (-150e4 4.
Mailing Address:
Contractor.
Mailing Address' 3707-L r�
City
State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
56.00
=
4
'SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
=
- 12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
1FOUNTAINS,
DRINKING
X
56.00
-
�`
`1
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR
REVERSALS
X
56.00
=
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
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS, BOILERS
X
$6 00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
36.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00.
_
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH CHECK
DATE I
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: