2004, 12-17 Permit App: 04009443 Plumbing ReversalPLUMBING PERMIT APPLICATION
ne Phone: (509) 688-0036; FAX: (509) 688-0037
'Valley For Inspections, Call (509) 688-0054
Project Address: 31 61 AL LO W(4- ' Permit Use
Owner
Mailing Address
State Zip Code
Phone #:
Community Development Department
Building Division
11707 E Sprague Avenue, Suite 106
Spokane Valley, WA 99206
0+1q43
Phone (Daytime Contact)
Contractor
Mailing Address.
City
License #
City
State
Zip Code
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
R OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
56 00
=
2
URINALS
X
56 00
=
3
TUBS
X
$6 00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56 00
=
5
SINKS
LAVS/BASINS, BAR. FLOOR, KITCHEN.
LAUNDRY. UTILITY. JANITOR, PHOTO.
X-RAY. FOOD, PREP/CULINARY MEAT
X
56 00
=
6
DISHWASHER
X
5600
=
7
CLOTHES WASHER
X
5600
=
8
GARBAGE DISPOSAL
X
56 00
=
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
$6 00
11
FLOOR DRAINS
AREA, CASE. COIL, TRENCH CONDENSATE
X
56 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56 DO
=
13
FOUNTAINS. DRINKING
X
$6 00
=
14
WATER PIPING/DAtNAJ WAS}E,
VENT, PLUMBING, REVERSAL/
NSTALLATION, ALTERATION, REPAIR.
REVERSALS
X
5600
=
P 0
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56 D0
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER. HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
56 00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R P B P D FOR VATS, TANKS, BOILERS
X
56 00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56 00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
X
$6 00
5600
=
20
MISCELLANEOUS PLUMBING
FLXTURE
21
PRIVATE SEWAGE DISPOSAUSYS
X
520 00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
METHOD OF PAYMENT'
0 CASH 0 CHECK
DATE
SUBTOTAL
(0•'00
535.00
0 VISA 0 MASTERCARD
PROCESSING FEE
EXPIRES
TOTAL PERMIT FEE DUE:
W("00
BANKCARD NUMBER
AUTHORIZED SIGNATURE: