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2005, 05-04 Permit App: 05001428 Plumbing Reversal, ROWPLUMBING PERMIT APPLICATION ne Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 Project Address: 'zl Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 lM Attu „�,•z, (� Permit Use: Owner j0 ng Mailing Address: I. 1 Phone (Daytime Contact): Contractor:/4Gc-,-, it a 5 Y 404-L.A, Mailing Address: `�iSz.l 1/1 11.1y ((( City License #: State Zip Code Phone #: 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 = 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 l X $6.00 = f G C_P C/ 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 DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: 0 CASH 0 CHECK DATE: SUBTOTAL ` _ 0 l(/ l/ �-7 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: Li I OO BANKCARD NUMBER: AUTHORIZED SIGNATURE: n Sp"lane 4,00Valley Call 24 hours before inspection required Phone 509.688-0195 Fax 509.688-0037 DEPARTMENT OF PUBLIC WORKS Anticipated start date Permit # ROW CONSTRUCTION PERMIT Location of property at fl Jo AR C-'� Vi i h Rd (Address/Parcel #, if available) Applicant Name % /i I Silel5.:�. Fax Address / 1 / / Phone Contractor's Name / or E Y i4 04 t‘ni Address 30"2 r ii) lily R) Phone 2..5"-/ — gOs X' Contractor's Reg.# l -G t '../.; ---g' .f 561 C D Expires 6" G %- O PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity) 1::' S wer Connection EI Driveway El Curb & Gutter D Gas Installation/Repair Cable/Conduit/Pole EJ Sidewalk Repair/Construction El Water Installation/Repair El Other Pavement Cut Dimensions Bond/insurance certification must be on file with the City. Bond # Permittee Signature Approved Date I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card. Card # Expiration Date Name of Holder Signature Fees Paid$ (Application) (Inspection) In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour) minimum. Permittee signature constitutes an agreement to these terms and provisions. Date 'nit Work completed satisfactorily (Signed) Date Permit not valid until One -Call Notification Ticket # entered here PERMIT MUST BE KEPT ON SITE