2004, 08-16 Permit App: BLD-04-07376 Plumbing ReversalMETHOD OF
❑ CASH
Spokane
Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Wiley, iA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: I I 1 1-7 r j/,,,(J ,/J 1 /1
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PERMIT
USE:
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OWNER:/ //• L / Py _^ 0 a z
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PHONE (Daytime Contact): q ct :5-2 / 0_
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MAILING ADDRESS:
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C Pe 0 I,b,9-970y)e
(street) (city/state)
(ZIP)
CO,[TFR: ( 0 ^ (% I („„n iL1 j� f AC.
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LICENSE 7:
MAILING ADDRESS: /
3 L/ /. S. d c/tt--n_ 1
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PHONE 1:
(i of / - 5_ 7 / 3
2
(street) (city/state)
(ZIP)
PLUMBING FIXTURES
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
-
2
URINALS
X
$6
-
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
-
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASE, VENT, PLUMBING •
REVERSAL
INSTA TION, ALTERATION, REPAIR,
R LS
/
X
$6
-
n
/' /
C
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
1..
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6 -
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
x
s6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
CHECK
r
•
-_. .
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
■ =UM ■
TOTAL PERMIT FEE DUE://
/'0
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE: