2004, 09-27 Permit App: BLD-04-07768 Plumbing Reversall �'� tr rvl 6, w.YY
tJ ,,,Valley\
Project Address: /7/ 47 4/ J r;, s I
Owner- g,1,n ,' r fr
Mailing Address: . $'nn7' /
Contractor:
Mailing Address:
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
Build7ngDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact): 9-,Z6 d 97-3
e9/ 7:17/-,//
//- r
City S ate Zip Code
License #: 77cro %7iiPhone #: in- 51,.. -3&F2
4 9 a99'
City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
_
BOF
UNITS
X
COST
la
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$8.00
4
SHOWERS (PER TRAP)
BATH STALL ONSITE 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
$6.00
-
7
CLOTHES WASHER
X
58.00
=,
8
GARBAGE DISPOSAL
X
$8.00
=
9
WATER SOFTENER
X
58.00
-
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
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,/
REPAIR, REVERSALS
X
58.00
co
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
58.00
=
18
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR. SWAMP COOLER
X
58.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK ' '
VALVE, AND RP.B.P.D. FOR
VATS, TANKS, BOILERS
X
$6.00
=
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 El CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES
SUBTOTAL
(l7 + 00
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
`/
7 l .
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: