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2005, 09-06 Permit App: 05003248 Sewer Reversal,'�,� Permit Center s iokan" a 11707 E Sprague Ave, Suite 106 400 i %alley Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevalley.ore.com Plumbing Permit Application o Commercial o Residential SITE ADDRESS 013 O t .e/xc;>Th Building ownerN .? ( s� �- �� Phone: Fax Address: -7 C1 `j f City /7C-41-,64,\_.,( � .,( State .0Zip ci cid. Contractor Name: Phone: Fax: Address: City State Zip License No: Name: h City Business License No: Phone: + �� ! e - c<i(-0 AUTHORIZED SIGNATUR 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 = /' /14 "WATER PIPING/DRAIDL.IpL.10L©STE, /VENT, PLUMBINZ"REVERSA) NSTALLATION, ALTERATION, REPAIR, REVERSALS I X $6.00 = / p� `r (_ ,-- 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 DISPOSAL/SYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: 0 CASH CHECK DATE: SUBTOTAL 0 VISA ❑ MASTERCARD PROCESSING FEE —_ $35.00 \ `� EXPIRES: ,t TOTAL PERMIT FEE DUE: �� (. C1 ( v AUTHORIZED SIGNATUR REVISED 8/26/05