2004, 04-16 Permit App: BLD-04-04101 Plumbing Reversal, FixturesS`pokan
0Ualley
Cft PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
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Project Address: // 3Q V N c' S Permit Use:
1C
Owner: /%%,`c 14,04 /,/%/c4
Mailing Address: SA -n' -P
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Phone (Daytime Contact):
City
/ State
Contractor: �fo1�_1r L ,NP cee s icense #: Ceurkt-4/x/Phone #:
Mailing Address: /n/ 8 E 9,,.49 e aca+oCne
Zip Code
uJrq
State
9&- s9 2s
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
6.00
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6.00
=
tp r d 0
5
SINKS
LAYS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
/
X
$6.00
=
/�
1P , o 0
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$600
=
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
$600
=
ar00
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
$6 00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR.
VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$600
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6 00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES.
SUBTOTAL
a el
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
4-5-7 ca
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code