2004, 04-16 Permit App: BLD-04-04102 Plumbing ReversalSpokane°",
Valley
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
Project Address: /6 2 2 4) /or, 5 A /Co/ Permit Use:
Owner: 779 ../..e/ e 6e7,
Mailing Address: SAm P
Phone (Daytime Contact):
Contractor L en; to
Mailing Address: /97/ $ F 3� h5 „
City State Ztp Code
Licensee #: (<'i/gcr,R7,P7Phone #J:
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City State ip Code
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6 00
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
5
SINKS
LAYS/BASINS, 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
$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
$8.00
=
13
FOUNTAINS, DRINKING _
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
/
X
$6.00
=
tea
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
$6 00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6 00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
/
cp,Q?
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
11197 , dO
BANKCARD NUMBER.
AUTHORIZED SIGNATURE: