2003, 08-18 Permit App: BLD-03-02254 Plumbing ReversalSpokane
1#Valley
Plumbing Permit Application
11707 East S:pragae Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call' 509-688-0054
PROJECT
ADDRESS: 7 (�&� lam,
l_12 L /,
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(14/4/ tor
PERMIT
USE:
OWNER:
Q
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PHONE (Daytime Contact):
MAILING ADDRESS
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,�(�� / ,,
i t t l ,mcA-1- SAM -xi? WGA X242 c//7
(street)
(city/state) (ZIP)
CRO�TgR.v man -f--)11
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LICENSE p:
MAILING ADDRESS: o
3tl1D S 7
43n 4..4s
S
10 a_
PHONE 4:
c I -5-9/ 3
q9 63
(street)
(city/state) (ZIP)
PLUMBING FIXTUR
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
14 SEWAGE EJECTOR
15 WATER USING DEVICE
NOTE. IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
NST' 11 TION, ALTERATION, REPAIR,
16 CROSS CONNECTION DEVIC
7 SPRINKLER SYSTEM
18 INTERCEPTOR$
9 MEDICAL GAS Per outlet
20 MISC. PLUMBING FIXTURE
THOD OF PAYMENT
:ASH 0 CHECK
E:
KCARD NUMBER:
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 1 $6
X I $6
X ) $6
X
$6
X I $6
X
$6
X ) $6
X I $6
X 52.5
X 56
X 1 56
X j $6
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUDE;
DESCRIPTION
DETAILS
4OFUNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X-
S6
2
URINALS
xS6
3 TUBS
X$6
4 SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X-
$6
5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X $6
-
6 DISHWASHER
X $
-
7 CLOTHES WASHER
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
14 SEWAGE EJECTOR
15 WATER USING DEVICE
NOTE. IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
NST' 11 TION, ALTERATION, REPAIR,
16 CROSS CONNECTION DEVIC
7 SPRINKLER SYSTEM
18 INTERCEPTOR$
9 MEDICAL GAS Per outlet
20 MISC. PLUMBING FIXTURE
THOD OF PAYMENT
:ASH 0 CHECK
E:
KCARD NUMBER:
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 1 $6
X I $6
X ) $6
X
$6
X I $6
X
$6
X ) $6
X I $6
X 52.5
X 56
X 1 56
X j $6
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUDE;