2005, 01-14 Permit App: 05000144 Plumbing Reversaljne
Vaiey
Project Address:
Owner: a m
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (5093 688-0037
For Inspections, Call (509) 688-0054
/
Mailing Address:
Contractor:
if Me L u h /`
5 f, Phone (Daytime Contact):
y l S s. -r L o ep,v
City State
License #:
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Mailing Address:
/VI
Zip Zip Code
Phone #:
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
URINALS
X
$6 00
=
3
TUBS
X
$6 00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
$6 00
=
5
SINKS
LAYS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6 00
=
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
$6 00
=
13
FOUNTAINS, DRINKING
X
$6 00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
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 R P B P D FOR VATS, TANKS, BOILERS
X
56 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
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15 00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: