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2004, 08-04 Permit App: BLD-04-07233 Plumbing ReversalSpokane 1 . Valley Plumbing Permit Application 11707 East Sprague,Aventie, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call' 509-688-0054 PROJECT ADDRESS: 005 j PERMIT USE: OWNER: i 4 ola PHONE (Daytime Contact): _ y- 3. / . iJa_ 7?c -0 Csa (ZIP) MAILING ADDRESS: I i (street) (city/state) COERY V 6140 -1)/1� (Ft ( i it LICENs8 #: MAILINGADDRESS: 3 i /D - 1 n -k cpm- s 6)ct__ PHONE #: _ �� qt::::. ( l 3 O (street) (city/state) (ZIP) . PLUMBING FIXTURES DESCRIPTION 1 TOILETS DETAILS 2 URINALS WATER CLOSET, BIDETS # OF UNITS X COST EQUALS AMOUNT 3 TUBS 4 SHOWERS (PER TRAP) 5 SINKS 6 DISHWASHER 7 CLOTHES WASHER 8 GARBAGE DISPOSAL 9 WATER SOFTENER BATH, STALL, ON-SITE BUILT LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- X $6 RAY, FOOD, PREP/CULINARY/MEAT X $6 X $6 X $6 = . X $6 10 ELECT. HOT WATER TANK 11 FLOOR DRAINS NOTE: IF GAS, SEE MECHANICAL 12 FOUNTAINS, DRINKING AREA, CASE, COIL, TRENCH, CONDENSATE 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING REVERSAL 14 SEWAGE EJECTOR 15 WATER USING DEVICE 16 CROSS CONNECTION DEVICE 17 SPRINKLER SYSTEM 18 INTERCEPTORS INSTALLATION, ALTERATION, REPAIR, REVERSALS GRINDER, SUMP PUMP ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, X $6 SWAMP COOLER X $6 = X $6 X $6 X $6 - X $6 X $6 X $6 = X $6 X $6 VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK NITROUS, OXYGEN X 66 = $25 = )D OF PAYMENT • ❑ CI-IECK 0 irY 'T RD NUMBER: EXPIRES: 7ZED SIGNATURE: $6 = SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: