2004, 08-30 Permit App: BLD-04-07510 Plumbing ReversalSpokane'
flValley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT
ADDRESS: 1 (7 ( LI
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PERMIT
USE:
OWNER: `/1 e
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PHONE (Daytime Contact):
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MAILING ADDRESS:
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4461, (/C)41
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(street)
(city/state) (ZIP)
WATER CLOSET, BIDETS
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LICENSE 4:
PHONE k: q:, 1 -591 3
MAILING �'
3 L! /cp S.
2
URINALS
(street)
(city/state)
56
-
3
TUBS
PLUMBING
9 WATER SOFTENER
10 ELECT. HOT WATER TANK (NOTE: IF GAS, SEE MECHANICAL
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
13 WATER PIPING/DRAIN-IN INSTALLATION, ALTERATION, REPAIR,
WASTE, VENT, PLUMBING REVERSALS
REVERSAL
14 SEWAGE EJECTOR GRINDER SUMP PUMP
15 WATER USING DEVICE
16 (CROSS CONNECTION DEVICE
17 SPRINKLER SYSTEM
X
$6
X 1 $6
X I $6
X I $6 1 -
X I $6
X
X 56
ICE AND/OR COFFEE MAKER, HOSE BB, I I I
STEAMER PROOFER, CARBONATOR X $6
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D, FOR VATS, TANKS, BOILERS
18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
19 MEDICAL CAS per outlet NITROUS, OXYGEN
20 MISC. PLUMBING FMTURE
IOD OF PAYMENT
MUM
SH ❑ CHECK ❑ MIMI❑
:ARD NUMBER
EXPIRES:
)RJZED SIGNATURE:
X $6 I -
X $25 1
X 1 56 1
X 1 $6
X 1 56
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL PERMIT FEE DUE:
DESCRIPTION
DETAILS
4 OF LIMES
X
COST
EQUALS
AMOUNT
I
TORETS
WATER CLOSET, BIDETS
X
56
`
2
URINALS
X
56
-
3
TUBS
X
$6
4
5
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X 56
SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X $6
-
6 DISHWASHER
X 86
7 CLOTHES WASHER
X S6
8 GARBAGE DISPOSAL
9 WATER SOFTENER
10 ELECT. HOT WATER TANK (NOTE: IF GAS, SEE MECHANICAL
11 FLOOR DRAINS
12 FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
13 WATER PIPING/DRAIN-IN INSTALLATION, ALTERATION, REPAIR,
WASTE, VENT, PLUMBING REVERSALS
REVERSAL
14 SEWAGE EJECTOR GRINDER SUMP PUMP
15 WATER USING DEVICE
16 (CROSS CONNECTION DEVICE
17 SPRINKLER SYSTEM
X
$6
X 1 $6
X I $6
X I $6 1 -
X I $6
X
X 56
ICE AND/OR COFFEE MAKER, HOSE BB, I I I
STEAMER PROOFER, CARBONATOR X $6
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D, FOR VATS, TANKS, BOILERS
18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
19 MEDICAL CAS per outlet NITROUS, OXYGEN
20 MISC. PLUMBING FMTURE
IOD OF PAYMENT
MUM
SH ❑ CHECK ❑ MIMI❑
:ARD NUMBER
EXPIRES:
)RJZED SIGNATURE:
X $6 I -
X $25 1
X 1 56 1
X 1 $6
X 1 56
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL PERMIT FEE DUE: