2004, 10-11 Permit App: BLD-04-07882 Plumbing ReversalT�\p PLUMBING PERMIT APPLICATION
SPlane
of Spokane Valley Community Development Department
BuildingDivision
Walley 11707 E. Sprague Avenue, Suite 106
Spokane Valley,06
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: YD %I/ C ,Yaxr i n54-0 n Permit Use:
Owner: Lett` G/eh e#1 71Qhtor4-1N vn IxSte-4' Phone (Daytime Contact): Soy-q•aq-7clyy
Mailing Address: IV 14 E Mii.2gTn7 {-cam 5p„fo,3-rcc Iris -II ey /A/4 9y -CI
i
City 1 State Zip Code
Contractor. License #: Phone #:
Mailing Address:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
-
*OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=-
2
2
URINALS
. -
X
$6.00
=
3
TUBS
X
$6.00
=-
4
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR. PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER_
X
$6.00
=
7
CLOTHES WASHER
X
$8.00
=
6
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=-
10
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$8.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$8.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATipN`ALTEN,
REPAI((RR, REVERSALS
(
X
$6.00
=
'A
bU
15
SEWAGE EJECTOR
X
$6.00
=
GRINDER, SUMP P
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
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
.(.CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
l.G. 0
CO �
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
` 11- w
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code