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2005, 03-22 Permit App: 05000868 Plumbing ReversalPLUMBING PERMIT APPLICATION AC Phone: (509) 688-0036; FAX: (509) 688-0037 di Va ion/ For Inspections, Call (509) 688-0054 05- q (07( Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Project Address: %®a s 3. MY! ay. ,,q�� /et Permit Use: Owner: /9'l,1.^ 54;4/! Phone (Daytime Contact): Mailing Address: 3,2,7* ,P Contractor: Mailing Address City License #: State 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 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 56 00 = 6 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 5600 = 13 FOUNTAINS, DRINKING X 56,00 14 WATER PIPING/DRAIN-IN WASTE. VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X 5600 = - COO 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.B.P.D. FOR: VATS, TANKS, BOILERS X 56.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 56 00 = 19 MEDICAL GAS (per outlet NITROUS, OXYGEN X 56 00 = 20 MISCELLANEOUS PLUMBING FIXTURE X 56.00 = - 21 PRIVATE SEWAGE DISPOSAL/SYS X 520.00 = 22 INDUSTRIAL WASTE . INTERCEPTOR - X 515.00 • METHOD OF PAYMENT: 0 CASH 0 CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL p rtn 6 PROCESSING FEE 535.00 . TOTAL PERMIT FEE DUE: . Vt/. C BANKCARD NUMBER: AUTHORIZED SIGNATURE: