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2003, 08-18 Permit App: BLD-03-02264 Plumbing ReversalIETHOD OF ] CASH /ATE. Slkane c0000Valley Plumbing Permit Application 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call 509-688-0054 1-4(04( PROJECT ADDRESS' /©67° err // r` SSPP i[t 3 4F bo'L� PERMIT USE: OWNER: /J le. lQ 4 i_/`4� PHONE (Daytime Contact): pa Oo S7 MAILING ADDRESS: re- % 7eU140 (street) (city/state) (ZIP) CONTRACTOR: t>"� /� fej (Lis �J1 .�C LICENSE #: G� o a cc !T' / 7 MAILING ADDRESS: / 9 /9 f't r ,- 5",-,4_ ,) e PHONE #: 4'd 9 - 9aY - S -y S c— P /11.-1,4-e $ 7?en / (street) (city/state) (LIP) S PLUMBING FIXTURES ANKCARD NUMBER UTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF LINITS 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 - 6 DISHWASHER X $6 - 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 - ID ELECT HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X $6 - 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS / X $6 - //, LQ r 00 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER HOSE BIB, STEAMER, TROOPER, CARBONATOR, SWAMP COOLER X $6 . 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X - 17 SPRINKLER SYS IEM X $25 - 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 66 - 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 - 20 MISC. PLUMBING HAI URE X $6 - PAYMENT ❑ CHECK CIEtie - iWas tK3d, _ - SUBTOTAL: op PLUS PROCESSING FEE: $35.00 y)Sq ❑ Eillein ■ TOTAL PERMIT FEE DUE: 'fj o 0 ANKCARD NUMBER UTHORIZED SIGNATURE: