2003, 08-18 Permit App: BLD-03-02253 Plumbing Reversal*lane
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
PROJECT
ADDRESS: I ( `� I r Jjyi I� . � �
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PERMIT
USE:
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OWNER: rex, 41 7 `�(/
(Daytime Contact):
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MAILING ADDRESS:
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(street) (city/state)
(ZIP)
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LICENSE #:
MAILING ADDRESS:
36//D S -ami -5
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PHONE #:
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(street) (city/state)
(ZIP)
PLUMBING FIXTURES
DESCRIPTION
1 TOILETS
2 URINALS
3 TUBS
DETAILS
WATER CLOSET, BIDETS
# OF UNITS X COST EQUALS AMOUNT
4 SHOWERS (PER TRAP)
5 SINKS
BATH, STALL, ON-SITE BUILT
X $6
X
X
X
$6
$6
$6
6 DISHWASHER
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
7 CLOTHES WASHER
X
$6
8 GARBAGE DISPOSAL
9 WATER SOFTENER
X $6
X
10 ELECT. HOT WATER TANK
11 FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
12 FOUNTAINS, DRINKING
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
SEWAGE EJECTOR
AREA, CASE, COIL, TRENCH, CONDENSATE
$6
X $6
X $6
X $6
X
WATER USING DEVICE
CROSS CONNECTION DEVICE
SPRINKLER SYSTEM
INTERCEPTORS
TION, ALTERATION, REPAIR,
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6
X $6
X $6
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D. FOR: VATS, TANKS, BOILERS
X $6
MEDICAL GAS per outlet
MISC. PLUMBING FDCTURE
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
X $25
X $6
$6
"HOD OF PAYMENT
ASH ❑ CHECK ❑
7.
(CARD NUMBER:
EXPIRES:
IORIZED SIGNATURE:
SUBTOTAL:
PLUS PROCESSING FEE: $35.00
TOTAL PERMIT FEE DUE:
1(.00