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2005, 04-18 Permit App: 05001217 Sewer ReversalAit„ *ft 4,Valky PLUMBING PERMIT APP!IC:AT-BION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 L r3e Project Address: ( Permit Use: Owner: J' p433—e/0 J/}�(,l L$ato �. 0 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 L_00(3 Phone (D State cm vile_ State Spokane Valley, WA 99206 05 -- 12 7 aytime Contact): Mailing Address: Contractor: Z - Mailing Address: -40 City Licen City 0 a_ eye917 Zip Code Phone #: Zip Code METHOD OF PAYMENT: ❑ CASH DATE: 0 CHECK BANKCARD NUMBER: ❑ VISA EXPIRES: 0 MASTERCARD SUBTOTAL PROCESSING FEE TOTAL PERMIT FEE DUE: $35.00 1i/ AUTHORIZED SIGNATURE: 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 $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6.00 = 5 SINKS LAYS/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 = i 8 GARBAGE DISPOSAL X $6.00 = 9 WATER SOFTENER X $6.00 = 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 $6.00 13 FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATIO N, REPAIR, REVERSA X $6.00 = 15 SEWAGE EJECTOR GRI ER, 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 = 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: ❑ CASH DATE: 0 CHECK BANKCARD NUMBER: ❑ VISA EXPIRES: 0 MASTERCARD SUBTOTAL PROCESSING FEE TOTAL PERMIT FEE DUE: $35.00 1i/ AUTHORIZED SIGNATURE: