2003, 11-03 Permit App: BLD-03-02963 Plumbing ReversalSfielan
.,Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane ValleypiNA 99206 509-688-0037 - Fax
For Inspections, call' 509-688-0054
PROJECT
ADDRESS: • U S,D
i, _ f
ERMIT
SE:
OWNER:
GP
PHONE (Daytime Contact if
MAILING ADDRESS:
I vS a5-
F. 1114:(2_)-.QCS
(street)
(city/state) (ZIP)
ant_R. V N ap
i) / I �1 (I i A8_
LICENSE #:
MAILING ADDRESS:\
3(1 /a S.5
40nR l
13
PHONE 4/: p-
�3 I -�yl 3
679 6., 4-7
(street)
(city/state) (ZIP)
2 URINALS
PLUMBING FI
9 WATER SOFTENER
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
PLUMBING
MEDICAL GAS per outlet
MISC. PLUMBING FIXTURE
THOD OF PAYMENT
.ASH 0 CHECK 0 Vn 0 L
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
E:
KCARD NUMBER:
EXPIRES:
-IORIZED SIGNATURE:
X
X
$6 'I
X s6
X ) $6 I
X j $6
X j $6
X $6
X ) $6
X $6 I•
X 1 $25 1
x 1 $6
X $6
X I $6 1 -
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE:
DESCRIPTION
DETAILS
4/ GE UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
2 URINALS
X
86
-
3 TUBS
X $6-
4 SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
5 SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
-
6 DISHWASHER
X$6-
7 CLOTHES WASHER
X $6
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
PLUMBING
MEDICAL GAS per outlet
MISC. PLUMBING FIXTURE
THOD OF PAYMENT
.ASH 0 CHECK 0 Vn 0 L
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
E:
KCARD NUMBER:
EXPIRES:
-IORIZED SIGNATURE:
X
X
$6 'I
X s6
X ) $6 I
X j $6
X j $6
X $6
X ) $6
X $6 I•
X 1 $25 1
x 1 $6
X $6
X I $6 1 -
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE: