2004, 09-09 Permit App: BLD-04-07599 Plumbing ReversalMalley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
_ BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: //608 .%zhm, /ZV Permit Use:
Owner.
Mailing Address: i(
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Mailing Address: ? a 7 l2l ///y Iz/
Phone (Daytime Contact):
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ity State Zip Code
License #: Phone #: 2.I'Sa
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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
X
$6.00
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR. PHOTO, X-RAY, FOOD,
PREP/CULINARYIMEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
=
e
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
$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 .
C
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
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA D MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: