2004, 10-22 Permit App: BLD-04-08013 Plumbing Reversal, FixturesSapoMane
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildrngDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: b.c ' MaxlDele I Permit Use:
Owner: (,\/1 V 14) pi Iif 4 -Av Y Tr -Ott I Phone (Daytime' Contact): 92-2_
Mailing Address: \ (1 ThS IAkA )>6 t)9k I LY1 Q VA— q
City . State Zip Code
Contractor. License #: Phone #:
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
TOTAL
AMOUNT
1
TOILETS •
WATER CLOSET, BIDETS
I
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
-
X
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE! BUILT
I
X
$6.00
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREPICULINARYIMEAT •
1
X
$6.00
=
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
=
B
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
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 DRAINSIOVERFLOW DRAINS
X
$8.00
=
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,f
REPAIR, REVERSALS
X
$6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$8.00
=
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, ANDRP.BP.D. FOR
X
-
58.00
.
VATS, TANKS, BOILERS
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
METHOD OF PAYMENT:-
0 CASH 0 CHECK ID VISA El MASTERCARD
DATE: EXPIRES:
- SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: