2008, 11-10 Permit App: 08004440 Cross Connect DeviceRECEIVED 11/07/2008 10:51 5096880037
11/07/2008 10:49 5094824310 DEC YARD CARE
Permit Center
117
11703 E Sprague Ave, Suite R.3
S'�ior'irane
cot:`L,j7 ,,,_spfl Spokane Valley, WA 99206
Ydlle .,YORCYQIE09)688-On37
Community Development
Plumbing Permit Application
SITE ADDRESS: _ l i !rl I I C in A
❑ Commercial
SV PERMIT CEMTERFR
PAGE 02/04
Residential
•
IIO11 1IV)(A1 IL-- 11,.-%.
Building (honer
p
Name• RE -0 en ActA l e
Phone:
Fax
State.
Zip
Addre,s ttQ.11 L Irpuirtejt-AC&.
aa. biatlyzatiks
Contractor
/1 1I j}
Name 40 YMCAaUare
-�/,,
Phone: Z/jj'ai -C3CS
City, . r6 `,
ra)C 1� /-,
SLMe'�
J��j /-.
- 20
Zip Is,.4..
Address: IR1/0G1�7
License No. rc yr t`, 1a
Yc ^--�--�L
City Bust l,lel
Contact
Name: 1 / er14-
Phone 21' l —r —94
S
2
3
DESCRIPTON OF WORK
TOILETS
WATER CLOSET
BIDETS
URINALS
TUBS
4
5
SHOWERS (PER TRAP)
SINKS
0
B
0
11
17.
13
14
15
16
17
18
9
20
21
22
GARBAGE DISPOSAL
WATER SOFTENER
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW GRAINS
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
CROSS CONNECTION DEVICE
INTERCEPTORS
EDICAL GAS Igor oUIIPU
MISCEL
NEOUS PLUMBING PIXTURE
RIVATE SEWAGE DISPOSAL/SYS
INOUSTRIAL WASTE INTERCEPTOR
BATH, STALL ON -SPE BUILT
LAVSIBASINS, BAR. FLOOR, KITCHEN,
LAUNDRY. UTILITY, JANITOR. PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
NOTE IF GAS. SEE MECHANICAL
AREA, CASE, COIL, TRENCH,
CONDENSATE
TALLATION, ALTERATION, REPAIR.
REVERSALS
GRINDER SUMP PUMP
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
?ROOFER, CARBONATOR, SWAMP
COOLER
VACUUM BREAK E.R, CHECK VALVE,
AND R P B P D• FOR: VATS, TANKS,
BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
OF UNITS
X
COST
50,00
X 36,00
X
00
x 56.00
8 00
% S000
METHOD OF PAYMENT:
DCASH ❑ CHECK 0 VISA
C$rd#
AUTHORIZED SIGNATURE:
REVISED 11/26/0$
EXPIRES:
VIN.
SG 00
38 Co
20,00
31500
SUBTOTAL
IOTA
AMOUNT
U7
00
PROCESSING FEE
TOTAL PERMIT FEE DUE:
535.00
444/1,00