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2005, 11-29 Permit App: 05004485 Plumbing ReversalSp Muriele1\1' . Va11ey Community Development Plumbing Permit Permit Center 11707 E Sprague Ave, Suite 106 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www spokanevallev ore.com PERMIT NUMBER: PERMIT FEE: — Application ❑ Commercial a:Residential SITE ADDRESS: Building owner Aft Milks( 1 -*I ( DESCRIPTION OF WORK I v Name: - Phone: Fax: Address: frit(S E rvM V City. State: Zip: .Contractor res -r. i PL4.1t..4I*iv/ $6.00 = �_ Name: es 4-,"'7 1 yArp I Phone: '112 - /St/ Fax: Address: X City: State: Zip: License No: 3 City Business License No: Contact ; X $6.00 Name: 4 Phone: BATH, STALL, ON-SITE BUILT AUTHORIZED SIGNATURE: crIl gra REVISED 8/16/05 DESCRIPTION OF WORK I v ' it 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 LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT X $6.00 = 6 DISHWASHER X $8.00 = 7 CLOTHES WASHER X $6.00 8 GARBAGE DISPOSAL X $6.00 = 9 WATER SOFTENER X $60D = 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 NSTALLATIO ERATION, REPAIR, / X $6.00 =1. EVERSALS 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 = 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15 00 = METHOD OF PAYMENT: /5 CASH 0 CHECK Card# SUBTOTAL 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 EXPIRES' TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: crIl gra REVISED 8/16/05