2004, 09-13 Permit App: BLD-04-07639 Plumbing Reversalsfi�I&ey
Project Address: 70 6 LA.
Owner: / ar / `P ` ,
Mailing Address: 70 Lo( --p
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
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CJ r/ / e Permit Use: .
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Phone (Daytime Contact):
/ r City
Contractor. j 40 Lk �i i , 2 (a .m h�i0 License #:0-4 Phone #: 9'c).-/- / 3
Mailing Address: 3'-/) a ,6*. d o o K4 ,n0 il) /9- 97 (),-
City Sta a Zip Code
State Zip Code
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
$6.00
=
=
3
TUBS
X
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
X
$6.00
$6.00
=
5
SINKS
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
$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
INSTALLATION ' ON,
REPAI-____9i� '� S
X
$6.00
=
/'LI
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
'
X
$6.00
II
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
II
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
X
$6.00
$6.00
=
=
•
20
MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
0 CASH E} CHECK
DATE
❑ VISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
PROCESSING FEE
35..000
TOTAL PERMIT FEE DUE:
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)
`9 1 a)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: