2005, 10-05 Permit App: 05003651 Plumbing Reversal_ Permit Center
Spokane 11707 E Sprague Ave, Suite 106
..Valley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevallev.ore.com
Plumbing Permit Application ❑ Commercial
T/
PERMIT NUMBER: /»
PERMIT FEE:
esidential
SITE ADDRESS 5 `;\ ' L- •
Building owner 1:22}-6...,&'\J
)---v\-4;9 XA(,--Z
# OF UNITS
X
Name:
=
Phone:
goNLl — Y 6'& 7
Fax
WATER CLOSET, BIDETS
Address:
1S -2,-z, . E
{ -(;a_Ja-C/C/-\
City
State
Zip
Contractor
X
$6.00
=
Name:
O (J v\-(1
Phone:
Fax:
X
Address:
/
City
State
Zip
License No:
X
$6.00
City Business License No:
5
Contact
LAYS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
Name:
6
Phone:
X
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
LAYS/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
=
4WATER
PIPING/DRAIN-IN WASTE,
PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
I
X
$6.00
=
L.s14)VENT,
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:
❑ CASH 0 CHECK
Card#
SUBTOTAL
❑ VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 8/26/05