2004, 11-04 Permit App: 04009018 Plumbing ReversalS 1.;\
#Malley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
SuifdingDivision
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: SO Permit Use:
Owner: L1 7-01/—1 O") Phone (Daytime Contact): q1`-1? It
Mailing Address. 3 OS( h., ,( -- - S fekA4 1/J%
/��-��`- City Stated / Zip Code
Contractor. Y / +`�_S( "moo-\ License #: Phone #: - / a `7 --v7 I
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
#OF.
UNITS
X
COST
-
TOTAL
AMOUNT
1
TOILETS I
WATER CLOSET BIDETS
X
- $6.00
=
2
URINALS
-
-
X
$6.00
3
TUBS
X
$6.00
i =
4
SHOWERS (PER TRAP)
BATH STALL, ON-SITE BUILT
-
X
$6.00
=
5
SINKS
,-
LAVSBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT -
'
X
$6.00
=
6
DISHWASHER
X
$600
=
7
CLOTHES WASHER
X
$6.00
El
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
I =
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
58.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
714
C
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION, .
REPAIR, REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
$8.00
a
16
WATER USING DEVICE
ICE AH/OR COFFEE MAKER,
HOSE BB, STEAMER, PROOFER,
CARBONATOR. SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
--- -
VACUUM BREAKER CHECK ' '
I X
VALVE, AND RP.B.RD. FOR:
t8.00
VATS, TANKS, BOILERS
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 )(CHECK ❑ VISA Q MASTERCARD
DATE _ - - - _... EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: