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2003, 07-21 Permit App: BLD-03-02063 Plumbing ReversalogoliNtah Spokane Walley Plumbing Permit Application 11707 East Sprague venue, Suite 106 509-688-0036 - Phone Spokane Vae:?; WAA99206 509-688-0037 - Fax For Inspections, call 509-688-0054 PROJECT ADDRESS: EC �� ,/'C; per„ �.J IlJ' PERMIT USE: ^ OWMAILERING �,,a/t `}� rOf/(-I l COST PHONE (Daytime Contact):Q�` (-gf,%�o-- v MAILING � DRESSf 8 570 I 6 � ` C/ ,6�, ,If .9 it Vr--- W (ZIP) (street) (city/state) circ vtan -OI i / A -n '^ / ,!(` $6 LICENSE 4: MAILING ADDRESS:LLjry o S 3 �l is5 /L(L��/,/W/, ,�- ‘--Spn% I (Jct_ 1 PHONE #: qc)' - 5q; 3 619 t), (street) (city/state) (ZIP) PLUMBING FIXTURES DISHWASHER 7 (CLOTHES WASHER 8 GARBAGE DISPOSAL 9 WATER SOFTENER 10 (ELECT. HOT WATER TANK 11 (FLOOR DRAINS 12 FOUNTAINS, DRINKING NOTE: IF GAS, SEE MECHANICAL AREA, CASE, COIL, TRENCH, CONDENSATE 13 WATER PIPING/DRAIN-IN WAS 1 E, VENT, PLUMBING REVERSAL 14 SEWAGE EJECTOR 15 I WATER USING DEVICE INSTAL ON, ALTERATION, REPAIR, REVERSALS 16 (CROSS CONNECTION DEVICE 17 SPRINKLER SYSTEM 18 (INTERCEPTORS 19 I MEDICAL GAS per outlet 20 (MISC. PLUMBING FIXTURE MOD OF PAYMENT :ASH 0 CHECK 0VISA E: KCARD NUMBER: ICE AND/OR COFFEE MAKER HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER VACUUM BREAKER CHECK VALVE, AND RP.B.P.D. FOR VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK NITROUS, OXYGEN EXPIRES: -IORIZED SIGNATURE: X X X X X X X X X X X X X X X $6 $6 $6 $6 $6 $6 $6 $6 $6 525 $6 56 $6 SUBTOTAL: PLUS PROCESSING FEE: TOTAL PERMIT FEE DUE: $35.00 DESCRIPTION DETAILS It OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 2 URINALS X $6 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 - 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT - X $6 DISHWASHER 7 (CLOTHES WASHER 8 GARBAGE DISPOSAL 9 WATER SOFTENER 10 (ELECT. HOT WATER TANK 11 (FLOOR DRAINS 12 FOUNTAINS, DRINKING NOTE: IF GAS, SEE MECHANICAL AREA, CASE, COIL, TRENCH, CONDENSATE 13 WATER PIPING/DRAIN-IN WAS 1 E, VENT, PLUMBING REVERSAL 14 SEWAGE EJECTOR 15 I WATER USING DEVICE INSTAL ON, ALTERATION, REPAIR, REVERSALS 16 (CROSS CONNECTION DEVICE 17 SPRINKLER SYSTEM 18 (INTERCEPTORS 19 I MEDICAL GAS per outlet 20 (MISC. PLUMBING FIXTURE MOD OF PAYMENT :ASH 0 CHECK 0VISA E: KCARD NUMBER: ICE AND/OR COFFEE MAKER HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER VACUUM BREAKER CHECK VALVE, AND RP.B.P.D. FOR VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK NITROUS, OXYGEN EXPIRES: -IORIZED SIGNATURE: X X X X X X X X X X X X X X X $6 $6 $6 $6 $6 $6 $6 $6 $6 525 $6 56 $6 SUBTOTAL: PLUS PROCESSING FEE: TOTAL PERMIT FEE DUE: $35.00