2004, 07-16 Permit App: BLD-04-07093 Plumbing Reversal��
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PLUMBING PERMIT APPLICATION
tiT",� �� — ��Q /ty of Spokane Valley Community Development Department
\, � BuildingDivision
�Ualley 11707 Sprague Avenue, Suite 206
^t E.
Spokane Valley, 106
( Phone: (509) 688-0036; Fax: (509) 688-0037
�,y,Lib-
jj FOR INSPECTIONS, CALL (509) 688-0054
Project Address: " f l I L/ b- OAA-leo..EV Permit Use:
t Phone (Daytime Contact):
(t r ' SP`'hw,F trek
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City State Zip Code
14Zl-,ter rke(rhl hal- License #: hone #: 7 S/-goSB
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Owner:
Mailing Address:
Contractor:
Mailing Address:
SpoS�1,
City
State
9?/"?
Zip 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
$600
=
4
SHOWERS (PER TRAP)
BATH, STALL ON-SITE BUILT
X
$6.00
=
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
=
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
INSTALLATION, 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
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
�
L .Ot)
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
t41.0
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: