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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