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2005, 03-07 Permit App: 05000695 Plumbing ReversalProject Address: Owner: Mailing Address: PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (50 91 6 811-003 7 For Inspections, Cali (509) 688-0054 CD QE - Contractor City Permit Use: Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 25 Phone (Daytime Contact): bo -n /8-17 ense #: a kit State Zip Code Phone #: Mailing Address: City State Zip Code BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS' X 56 00 = 2 URINALS X 5600 = 3 TUBS X 56.00 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 56 00 = 6 DISHWASHER X 5600 7 CLOTHES WASHER X 56 00 = 8 GARBAGE DISPOSAL X 56 00 = 9 WATER SOFTENER X 56.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X 56 00 11 FLOOR DRAINS AREA, CASE. COIL, TRENCH, CONDENSATE X 56.00 = 12 ROOF DRAINS/OVERFLOW DRAINS ' X 56 00 = 13 FOUNTAINS, DRINKING X 56 00 = 14 E/ WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATIONr ALTERATION- REPAIR, ('REVERSALS ' X 56.00 = tt \ `I O 15 SEWAGE EJECTOR GR ER, SUMP PUMP X 56 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 6 P.D. FOR: VATS, TANKS, BOILERS X 56 00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 56 00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X 56.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X 56.00 = 21 PRNATE SEWAGE DISPOSAL/SYS X 52000 = 22 INDUSTRIAL WASTE INTERCEPTOR X 51500 = METHOD OF PAYMENT: 0 CASH CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL l_ 0 lJ lJ PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: (/ (- DO BANKCARD NUMBER: AUTHORIZED SIGNATURE: