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2004, 10-25 Permit App: BLD-04-08026 Plumbing ReversalProject Address: Owner: ,e/c/7L4 4 Mailing Address: PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Permit Use: Phone (Daytime Contact): Zip Code Phone #: X11 Z y3 2 j ? /I/o Zip Code Contractor: ]_)/44 6)444/&----72 Mailing Address: '/ V AibLl� r City License #: City State 2 - State BANKCARD NUMBER: 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 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 = 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 NSTALLATION, ALTERATION, REPAIR, REVERSALS 1.6 X $6.00 = IQ. �1 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 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: ❑ CASH 0 CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL 1 0 PROCESSING FEE $35.00nnn TOTAL. PERMIT FEE DUE: 1 1. V v BANKCARD NUMBER: AUTHORIZED SIGNATURE: