2005, 05-05 Permit App: 05001447 Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036;4:AX:'f 509) 688-0037
For Inspections, CaII (509) 688-0054
Project Address: if 705
Owner c
mmx,ll
Mailing Address:
Community Development Department
ilding Division
11707 - pragueAven.e Suite 106
Spokane Valley, 99206
Permit Use:
Phone (Daytime t): -i
Contractor:T t TsJ - P C& m L r
City
License #:
Staten5 Zi Code
hone #: 9 Z2 -1f9
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
cry 7/7„4
DESCRIPTION OF WORK
S OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
36.00
=
2
URINALS
X
$6.00
=
3
TUBS
+
X
56.00
4
SHOWERS (PER TRAP)
BATH. STALL ONSITE BUILT -
X
$6.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR. PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
-
$6.00
=
6
DISHWASHER
X
36 00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER -
X
56.00
=
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
36.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT. PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
36.00
=
/
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
-
X
36.00
=
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
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP.
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
36.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315.00
=
/C
METHOD OF PAYMENT:
SH 0 CHECK
DATE
0 VISA 0 MASTERCARD
SUBTOTAL
�,
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
,$/35.00
71,0
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
cry 7/7„4