2005, 05-11 Permit App: 05001510 Plumbing Reversalni>ge
Project Addre s
Owner:
Mailing Address.
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX:,(5.09)888-0037
For Inspections, CaII (509) 688-0054
�SS/
Contractor:z-
Mailing Address:
City
Licen
/lefty
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
iszo
Phone (Daytime ontact): 05701 --&-39/
State Ip 2ec'
Code
itict
State
Phone #
976?/4
Zip Code
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56 00
=
2
URINALS
X
5600
=
3
TUBS
X
56 00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56 00
5
SINKS
LAVS/BASINS, BAR. FLOOR. KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY. FOOD. PREP/CULINARY MEAT
X
56 00
=
6
DISHWASHER
X
56 00
7
CLOTHES WASHER
X
$6 00
=
8
GARBAGE DISPOSAL
X
56 00
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56 00
11
FLOOR DRAINS
AREA. CASE, COIL, TRENCH. CONDENSATE
X
56 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6 00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE.
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
CRCVERSALSD
/
X
5600
=
0-0 ���
- v / 1
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56 00
�.!
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
56 00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK VALVE,
AND R P.6 P D FOR' VATS. TANKS. BOILERS
X
56 00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
5600
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 00
20
MISCELLANEOUS PLUMBING
FIXTURE -
X
5600
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
52000
22
INDUSTRIAL WASTE
INTERCEPTOR
X
51500
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK
DATE.
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES
TOTAL PERMIT FEE DUE:
6747/6
BANKCARD NUMBER
AUTHORIZED SIGNATURE: