2003, 10-20 Permit App: BLD-03-02819 Plumbing ReversalSpokane'
jValley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call509-688-0054
PROJECT (���/�/ "C,.�fJ�
ADDRESS 91� I ! 1. C/
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PERMITpi n 1 ��/J ��
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PHONE (Daytime Contact):
111
MAILING A DRESS:
q !( `-7 30
0- — IC)490-4 ALI,
(i)t 91%.16-16
(street)
(city/state) (ZIP)
1
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LICENSE 4:
X
MAILING ADDRESS: "
3 (l lD S. ada�rg-
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S
13
PHONE A':
Cl. 1 - 5---9/ 3
X19 6
URINALS
(street)
(city/state) (ZIP)
X
PLUMBING FIXTUR
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
4 SEWAGE EJECTOR
15 WATER USING DEVICE
6 CROSS CONNECTION DEVICE
17 SPRINKLER SYSTEM
18 INTERCEPTORS
19 MEDICAL GAS per outlet
20 MISC. PLUMBING FIXTURE
MOD OF PAYMENT
,ASH 0 CHECK
E:
KCARD NUMBER:
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
ON, ALTERATION, REPAIR,
RE RSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
EXPIRES.
-IORIZED SIGNATURE:
X
$6
X I $6
X j $6
X $6
X 1 56
X
$6
X I 56
X 1 525
X I 56
X 1 $6
X 56
SUBTOTAL:
•
•
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE:
DESCRIPTION
DETAILS
4 OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
S6
-
2
URINALS
X
16
-
3 TUBS
X
$6
4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT
X
_-
5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6 DISHWASHER
X
56
-
7 CLOTHES WASHER
X
$6•
8 GARBAGE DISPOSAL X
$6-
9 WATER SOFTENER
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
4 SEWAGE EJECTOR
15 WATER USING DEVICE
6 CROSS CONNECTION DEVICE
17 SPRINKLER SYSTEM
18 INTERCEPTORS
19 MEDICAL GAS per outlet
20 MISC. PLUMBING FIXTURE
MOD OF PAYMENT
,ASH 0 CHECK
E:
KCARD NUMBER:
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
ON, ALTERATION, REPAIR,
RE RSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
EXPIRES.
-IORIZED SIGNATURE:
X
$6
X I $6
X j $6
X $6
X 1 56
X
$6
X I 56
X 1 525
X I 56
X 1 $6
X 56
SUBTOTAL:
•
•
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE: