2004, 06-08 Permit App: BLD-04-04533 Plumbing ReversalCombe City of Spokane Valley Community Development Department
PLUMBING PERMIT APPLICATION
(J1I�r111111 BuitdngDivision
11707 E. Sprague Avenue, Suite 106
Valley od ✓ �5�
Phone:Spokane Valley, WA 99206
\\ (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
Mailing Address. ,O !(o S Actei/'`& 44/ S/ole-' %0. 7-0o
City State Zip Code
Phone #:
Project Address: .k, //og XcccXr- u r
Owner: /"t-u-nt .. A .
Contractor: License #:
Mailing Address:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
a
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
$8.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
X
36.00
=
PREP/CULINARY/MEAT
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$8.00
=
8
GARBAGE DISPOSAL
X
$8.00
=
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
36.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$8.00
=
13
FOUNTAINS, DRINKING
X
$6.00
714 /WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$8.00
=
/ 00
!Y
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
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
36.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
36.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
335.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code