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
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Name:
-
Phone:
Fax:
Address: frit(S
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City. State:
Zip:
.Contractor res -r.
i PL4.1t..4I*iv/
$6.00
=
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Name: es 4-,"'7
1
yArp
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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
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' 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