2005, 09-12 Permit App: 05003344 Sewer ReversalSpokan' e~`'
,r,��Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www. spokan eval I eY. ore. coni
Plumbing Permit Application
SITE ADDRESS
PERMIT NUMBER:;
PERMIT FEE:
o Commercial o Residential
s_
VY
Building owner
,,i. AA ,
# OF UNITS
X
COST
=
TOTAL AMOUNT
Name:
TeR 1I,
Phone:
Fax
$6.00
=
Address:
t/ C4' fri, du
City
State
=
Zip
3
Contractor
7—Z C _
X
$6.00
=
4
SHOWERS (PER TRAP)
Name:
op rr. ✓t ¢t t'
a ,,
Phone:
_
-/S !,..-.3 ��
Fax:
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
Address:
LJ O
$6.00
=
City pr.,,,
State
Ida
Zip
79,6 /5 y
License No: 7-7
e r) *-16- i U 7
I'
City Business Lic se No:
CLOTHES WASHER
X
Contact
Q
8
GARBAGE DISPOSAL
X
$6.00
Name:...1):'12-1731.4,
9
Phone:
v f_ 41 i. -
X
$6.00
=
AUTHORIZED SIGNATURE:
REVISED 8/26/05
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
X
$6.00
=
/
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:
ASH 0 CHECK 0 VISA 0 MASTERCARD
Card# EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
/ / eV)
AUTHORIZED SIGNATURE:
REVISED 8/26/05