2005, 10-20 Permit App: 05003956 Sewer ReversalPermit Center
Spokane 11707 E Sprague Ave, Suite 106
.00,00ley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.ore.com
Plumbing Permit Application
PERMIT NUMBER: ,��)
PERMIT FEE: 4 / -
❑ Commercial ❑ Residential
SITE ADDRESS:
Building owner
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
Fax:
1
TOILETS
Name: _ j •N_/,,,.1 ,=Phone:
Address: f L9 2 7-c / i s •S i 1./6.
A t/'l_
City: jr. n Kt:,, t ,I State: j„/ A Zip:
1 r+ 3
7
/"
Contractor G A (1 .rl,/,--, a /.1Q
URINALS
X
Name: fl A i in 2- Ce,„„ rriL A . ,.,1
=
Phone: Fax:
3
TUBS
,i
Address: / (1),4! R Sp/'1-_Cy+ , 1-4.Y1
City : r,rvi.:,,-.,.State: Lti/° Zip:
4/4U7
‘
License No: /
4
City Business License No:
BATH, STALL, ON-SITE BUILT
Contact 0 i r '„,,..v., CA i Trja C,.., , A
$6.00
=
5
Name:
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
Phone:
X
$6.00
AUTHORIZED SIGNATURE:
REVISED 8/26/05
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
/
X
$6.00
=
` -D
(
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
Card# EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.000
TOTAL PERMIT FEE DUE:
--3a7-1/,400
AUTHORIZED SIGNATURE:
REVISED 8/26/05