2004, 10-04 Permit App: BLD-04-07835 Sewer, Plumbing ReversalSinpaane
Walley
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
991 i 2 Permit Use:
Phone (Daytime Contact):
_5;crsl4-c
C9/7
City State Zip Code
Phone #: 2(g - 3762
Project Address' c52O r M!9,/1/
Owner D c,A
Mailing Address: .544/e4(3
"� /`{3 "y F
Contractor, t'>JQwlni ae-A h
Mailing Address:
iCrdee
License #:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
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
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR. PHOTO, X-RAY, FOOD.
PREP/CULINARYIMEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER -
X
$6.00
=
6
GARBAGE DISPOSAL
-
X
- $8.00
9
WATER SOFTENER
•
X
$6.00
=
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
r
r
X
$8.00
/ ` 0O
(�
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.PB.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
$6.00
=
METHOD OF PAYMENT:
❑ CASHCHECK Q VISA 0 MASTERCARD
— II — 0 V EXPIRES:
DATE IC)'$
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
yb DO
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code