2006, 06-12 Permit App: 06002284 Sewer ReversalSpoKaae
e . Valley
Community Development
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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Plumbing Permit Application
❑ Commercial
PERMIT NUMBER (ARJ �oC
PERMIT FEE:
❑ Residential
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SITE ADDRESS:
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Phone:
Fax:
Address:
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State:
Zip:
License No:
City Business Lic:
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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 ONSITE 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
$8.00
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
x
$6.00
9
WATER SOFTENER
X
$6.00
10
r 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
15
WATER PIPING/D
VENT, PLUMBI , REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
1
X
$6.00
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:
OCASH 0 CHECK 0 VISA 0 MC
Card#
AUTHORIZED SIGNATURE:
REVISED W6/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.D0
TOTAL PERMIT FEE DUE: