2004, 09-16 Permit App: BLD-04-07672 Plumbing ReversaliSila e
galley
Project Address: I LOC /11,%,-(c- C(
Owner.
Mailing Address: ( S , l
Contractor: Ci c,J e / C O n S Fr d Gki J.1
Mailing Address: 57(77 P. 2�
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use: QNPJ[ sw�
Phone (Daytime Contact): 1.-15?- cao
poL.,C . 99ZflC„
rnl
city State Zip Code
License #: L le-OtooniPhone #: 219- ogee(
s�6lG.... .. C
City State Zip Code
v />L
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
— v 7 cp -7 —
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
56.00
=
5
SINKS
LAVSIBASINS, 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 .._
a
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
$8.00
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPIMG/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=
l/� OCJ
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 RP.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
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
J �
1S•oz
J
PROCESSING FEE
TOTAL PERMIT FEE DUE:
l '$35.001,
'y I - 00
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
— v 7 cp -7 —