2005, 08-17 Permit App: 05002968 Plumbing Reversal, FixturesPLUMBING PERMIT APPLICATION Community Development Department
*lane
Building Division
Phone: (509) 688-0036; FAX: (509).688-Q037 11707 E. Sprague Avenue, Suite 106
aileY — For Inspections, Call (509) 688-0054 OS? n Spokane Valley, WA 99206
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4 Sq CD
Project Address:, )I—)LD F h-,444„..t::7/ Permit Use:
Owner. jar-4 Sok, A/aI
Mailing Address: / l -,
Phone (Daytime Contact):
City
. Contractor. /4t ., a— f ye, , i.3. License #:
Mailing Address: kti My 2c! S
1
State Zip Code
Phone #: ? 5 Soe
SSzi,
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE
DESCRIPTION OF WORK
a OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
36.00
=
`
2
URINALS
X
36.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH STALL, ONSITE BUILT
i
X
36.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
g
X
36.00
=
6
DISHWASHER
X
36.00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
36.00
=
9
WATER SOFTENER
-
X
36.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
36.00 .
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
36.00
=
13
FOUNTAINS, DRINKING
X
36.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
/
X
36.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
36.00
=
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
36.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
36.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
36.03
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
320.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE