2004, 04-19 Permit App: BLD-04-04114 Plumbing Reversal, Fixture*lane°\
Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
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: 0°3 - ///en E,n4yu�El/ Permit Use:
Owner: �z/.ea, Shrill// Phone (Daytime Contact):
Mailing Address: H / / / 4pai,L,,- 4-caf-9.>.,-7
/City State Zip Code
Contractor: te
24u.,-,f�ioi,F✓ G
Mailing Address: 3d=-7_/ /7 /, %,f ,1
License #: GIBzt L? Phone #:
Z.57-goSe
'city
State
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
4 iz
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
f
X
$6.00
=
2
URINALS
X
$600
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
IAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$600
=
6
DISHWASHER
X
$6 00
=
7
CLOTHES WASHER
X
$6 00
8
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 DRAINS/OVERFLOW DRAINS
X
$600
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
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, AND R.P.B.P.D. FOR
VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$800
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00 .
_
METHOD OF PAYMENT:
❑ CASH 0 CHECK C VISA 0 MASTERCARD
DATE. EXPIRES
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER.
AUTHORIZED SIGNATURE:
4 iz
Zip Code