2003, 10-24 Permit App: BLD-03-02894 Plumbing ReversalSpoekanne
PLUMBING PERMIT APPLICATION
PROJECT
`I pI ..}—
ADDRESS: 5d / k cir,tti-t l�
DESCRIPTION
PERMIT
USE:
I
OWNER: �� yl�. / " ��,�
X
PHONE (Daytime Contact): Ljaa. �R so ti
MAILING ADDRESS: S n AA e�
AMOUNT
(street)
Spokane . (ZiP) S9W-2o,1
CONTRACTOR:
' N 4,3 CioNs./tRt.:,c7"ioIU
_(city/state)
LICENSE #:
N S CnN **- /?3KF
MAILING ADDRESS:
p m £ Ualleywo-y
pm
See
PHONE It: !o
�J
[a(o— 89‘i
Kan c, Wo-. . /%a 010
(street)
{city/state) (zip)
G'FIXTURES
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
a
2
URINALS
X
$6
a
3
TUBS
X
$6
a
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6
=
6
DISHWASHER
X
$6
=
7
CLOTHES WASHER
X
$6
=
6
GARBAGE DISPOSAL
,
X
$6
a
9
WATER SOFTENER
X
$6
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
a
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6
=
12
FOUNTAINS, DRINKING
X
$6
a
13
WATER PIPING/DRAIN-IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
r
X
$6
=
e..cs0
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
a
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6
a
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
a
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$8
_
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
a
-
-
SUBTOTAL
It f`,,; ,, ,;.
•
CASH ■ CHECK E1.
a` -- ■ v-".;•.--::.'‘.
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
WILL ONLY BE ACCEPTED WITH PAYbENf
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
iii- 0 O
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: