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: