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„
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PERMIT
USE:
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OWMAILERING
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COST
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(ZIP)
(street) (city/state)
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$6
LICENSE 4:
MAILING ADDRESS:LLjry o S
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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