2004, 09-13 Permit App: BLD-04-07637 Plumbing ReversalSnpoMane
4,1/alley
Project Address: ?Ain C-- ff9x2 -46-7-bel
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BulldingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR IN ECTIONS, CALL (509) 688-0054
Permit Use: SA--\
Owner: 4r7 7' /1572.-)
Mailing Address: b' Zc 7 fh9s4fr�t-ro f c/.0E4-,-'G
• Phone (Daytime Contact):
City
I C' State Zip Code
Contractor. D.% Itii2KL License #:`4Kb%T t'2c Phone #: 73?o
Ma'ling Address: /4S07 S• f�/�//c-- c16/et C 2ct- /u3 J
rCity
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
. .. r . -'
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
X
$6.00
=
5
SINKS
LAVSIBASINS, 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
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$600
=-
10
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
_
X
56.00
=
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
INSTALLATION, ALTERATION,(
REPAIR, REVERSALS
X
$6.00
/ DO
lam'
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
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
/I __
V '% 3
PROCESSING FEE
$35.00\0,
TOTAL PERMIT FEE DUE:
\\
'\ l -w
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code