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2004, 11-08 Permit App: 04009029 Plumbing Reversal, FixturesProject Address: PLUMBING PERMIT APPLICATTON Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 Owner: pay D-& &, S' Mailing Address: / Contractor: Mailing Address: 302,/ PLJ1;71/7 CI le - ity License #: 4y - Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Qd” Permit Use: Phone (Daytime Contact): State Zip Code Phone #: State Zip Code BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS ( X $6.00 = 2 URINALS X $6.00 = 3 TUBS X $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT t.'""....1 // 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 36.00 = 8 GARBAGE DISPOSAL X 36.00 = 9 WATER SOFTENER X 36.00 = 10 ELECTRIC HOT WATER TANK NOTE IF GAS, SEE MECHANICAL X 36.00 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6.00 = 12 ROOF DRAINS/OVERFLOW DRAINS X $6 00 = 13 FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6.00 = 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 $8.00 = 19 MEDICAL GAS (per outlet) ' NITROUS, OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20 00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15 00 = METHOD OF PAYMENT: 0 CASH 0 CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL PROCESSING FEE 335.00 TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: