2004, 03-17 Permit App: BLD-04-03795 Plumbing Reversal, Fixturesi
*lane
alley
Project Address: %i %Z3 t -61/t, 2-,
Owner: %'o,5 %i,.hlr
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
Permit Use:
Phone (Daytime Contact):
Mailing Address: 67z3 ,ern -,r. 5A-sti-,err
City
Contractor: /inti -.e •i,�,a-,,,,.--� License #: 3./ 0
Mailing Address: 3o-2-/ /7 I/1 ii
5/0104.6 ,ter
City
7
State Zip Code
Phone #: as-/ -pc)C '
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
2'977 L7
Zip Code
DESCRIPTION OF WORK
_
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
(
X
$6.00
2
URINALS
C
X
$600
=
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
$6 00
7
CLOTHES WASHER
X
$6 00
=
B
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE' IF GAS, SEE MECHANICAL
X
$8.00
=
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
1 li
X
$6.00
=
7
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
=
METHOD OF PAYMENT: '
❑ CASH ❑ CHECK ❑ VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
2'977 L7
Zip Code