2004, 11-23 Permit App: 04009149 Plumbing Reversal, Sewer(0 �-/ - 0/ / '�-/ �
- PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
Bul ingDivision
if 707 E. Sprague Avenue, Suite 106
r Spokane VaNey, WA 99206
Prone: (509) 688-0036, Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509} 688-0054
Project Address:Permit Use:
Owner %f� ='.,t; t' Phone (Daytime Contact):
Mailing Address:
A-
C State Zip Code
License #: Q il-P_ Phone #: 61c>
r
Contractor 400
Mailing Address:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
x
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET BIDETS
X
$6.00
=
2
URINALS
X
$6-00
=
3
TUBS
X
$6•0
_
4
SHOWERS ER TRAP
BATH STA ONSITE BUILT
X
56.00
=
5
SINKS
kAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANROR, PHOTO, X-RAY, FOOD,
PREPICULINARYIMEAT
X
$6.00
=
6
DESHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6•0
_
B
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$&00
=
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
56.00
_
13
FOUNTAINS DRINKING
X
$6.00
=
14
WATER PtPINGIDRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAI EVERS�S
X
$6.00
15
SEWAGE EJECTOR
GRINDER SUMP PUiMP
X
$6.00
16
WATER USING DEVICE
ICE ANIOR COFFEE MAKER,
140SE 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 r outlet
W17ROUS OXYGEN
f X
1 $6.00
=
20
1 MISCELLANEOUS PLUMBING FDCTURE4
I X
1 $6.00
=
METHOD OF PAYMENT:
❑ CASH [} CHECK ❑ VISA ❑ MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
`)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code