2005, 09-30 Permit App: 05003599 Plumbing ReversalPermit Center
Spoka`nye 11707 E Sprague Ave, Suite 106
Tilley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www spolanevalley of e cont
Plumbing Permit Application o Commercial (Residential
PERMIT NUMBER:
PERMIT FEE:
SITE ADDRESS
Building owner
DESCRIPTION OF WORK
..1.
# OF UNITS
X
/
Name: Iii I h-lP`` Debbs- 11,41C9 A''‘
�,/��S'-
Phone: �S//Y1-%�D' N/
Fax
1
Address: /S% /4"--E. rr#v.
WATER CLOSET, BIDETS
City 4P0/tine ees/rpState
01 1- Zip
Contractor 5'111 k-4 tit /So.,/ hVer/4 h -
=
2
Name:
Phone:
Fax:
$6 00
Address:
City
State
Zip
License No:
X
City Business License No
=
Contact. -
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
Name:
Phone:
5
SINKS
AUTHORIZED SIGNATURE:
REVISED 8/26/05
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
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
$6.00
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
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6 00
=
13
FOUNTAINS, DRINKING
X
$600
=
14
WATER PIPING/DRAIN-IN WASTE.
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
/
1
X
$600
=
Q l'
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 RP BPD FOR: VATS. TANKS, BOILERS
X
$6 00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$600
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN .
X
$6 00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20 00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$1500
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
Card#
❑ VISA ❑ MASTERCARD
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES
TOTAL PERMIT FEE DUE:
U(,
AUTHORIZED SIGNATURE:
REVISED 8/26/05