HomeMy WebLinkAbout2005, 09-14 Permit App: 05003393 Plumbing ReversalPermit Center
Spokane 11707 E Sprague Ave, Suite 106
dateSUalley Spokane Valley, WA 99206
(509)688-0036 FAX• (509)688-0037
Community Development www spokaneval ley ore con
Plumbing Permit Application
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PERMIT NUMBER: 3361 2,
PERMIT FEE:
-
❑ Commercial o Residential
SITE ADDRESS /7
Building owner
DESCRIPTION OF WORK
# OF UNITS
X
Name
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Phone: LA2//4g9'
Fax
WATER CLOSET, BIDETS
Address.
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City' , teats
State Kt Dig
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zip 9 /o! 11(
Contractor
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X
$6.00
=
Name:
3
TUBS
Phone:
Fax:
X
Address-
=
City
State
Zip .
License No:
X
$6 00
City Business License No:
5
Contact.
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
' $6.00
=
Name:
6
DISHWASHER
Phone:
X
AUTHORIZED SIGNATURE:/,7%q/J ,ekfj1iJ
REVISED 826/05
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
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
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
$6 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:
�6PROCESSING
. CASH ❑ CHECK - 0 VISA 0 MASTERCARD
Card# EXPIRES i
SUBTOTAL
FEE
535.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:/,7%q/J ,ekfj1iJ
REVISED 826/05