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2005, 03-03 Permit App: 05000663 Plumbing Reversal
Project Address: PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 ©3 /1Z��:,s� Ri Permit Use: Owner: . {VA/.. L 7 4107 Mailing Address: //a et) Jo , , , g 71 ted City Contractor: / C (-7,-)4471;;;‘,..te, License #: Mailing Address: ?'o& {-h� ,/ ,ed TrU3 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone (Daytime Contact): ChrO,-ct City State Zip Code Phone #: 7pery5/ i#,9,4 State Zip Code BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X 56 00 = 2 URINALS X 5600 3 TUBS - - X 56.00 = 4 SHOWERS (PER TRAP) BATH. STALL, ONSITE BUILT X 56 00 = 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X -RAV, FOOD, PREP/CULINARY MEAT X 56 00 = 6 DISHWASHER X 56.00 = 7 CLOTHES WASHER X 56 00 = 6 GARBAGE DISPOSAL X 56 00 = 9 WATER SOFTENER X 5600 = 10 ELECTRIC HOT WATER TANK NOTE. IF GAS, SEE MECHANICAL X 56 00 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X 56 00 = 12 'ROOF DRAINS/OVERFLOW DRAINS X 5600 = 13 FOUNTAINS, DRINKING X 56.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS / ! X 56 00 = 6 00 15 SEWAGE EJECTOR GRINDER, SUMP PUMP X 56 00 = 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 56 00 - 20 MISCELLANEOUS PLUMBING - FLXTURE X 5600 = - 21 PRIVATE SEWAGE DISPOSAUSYS X 520.00 22 INDUSTRIAL WASTE INTERCEPTOR X 51500 = METHOD OF PAYMENT: ' 0 CASH 0 CHECK 0 VISA ❑ MASTERCARD DATE: EXPIRES. SUBTOTAL PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: ?l OD BANKCARD NUMBER: AUTHORIZED SIGNATURE: