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: