2004, 11-17 Permit App: 04009094 Plumbing ReversalProject Address: Q Y 7
Owner: / d n / Phone (Daytime Contact): 9tD(, - SO % —
f. a aA/et) PJf . 560R6fiti (,JA 99070
f fl i d4au toi/
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-00315; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Mailing Address: ! / 7
/ (r itY State Zip Code
Contractor. "sip Lk i1!) p f / (.l kir License License #: fl i/ -P_ Phone #: gat -6-7/ 5
Mailing Address: 3 t// a S.d((Yi 4 5 t..H4 # 0 0) /9- 99193 7% -
City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
#OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
.---
2
2
URINALS
X
56.00
=
3
TUBS
X
$8.00
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
= -
8
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
SB.W
=
B
GARBAGE DISPOSAL
_ - _ _ _ _ -
..
X
$6.00
=
- ._
9
WATER SOFTENER
X
58.00
=
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,
/
X
$8.00
7 `(in
f
REPAIRCREVERSAi.
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 RP.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: -
0 CASH ❑ CHECK
DATE:
0 VISA ❑ MASTERCARD
EXPIRES: - -
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
/J3§.00
/(L /22
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: