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2004, 09-14 Permit App: BLD-04-07649 Plumbing Reversaln glpoliane doolValley Project Address:( -67 z 7 t x o ,� v5k Owner III� ev j or, l9'71 v< PLUMBING PERMIT APPLICATION City of Spokane Valley Community Development Department BuildingDivision 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax: (509) 688-0037 FOR INS , ECTIONS, CAL (q (509) 688-0054 Permit Use: Phone (Daytime Contact): G1,1. Y Mailing Address: P Q G v X 03 5g01(_04 (A p , 6/460,0o- 0 702 City State Zip Code License #:��„r c �'�f$ IV Phone #: act5'v' S' Contractor: C ©,k v` C --a 14: / Mailing Address: lq ' A 1 = Lt-( City State BANKCARD. NUMBER: AUTHORIZED SIGNATURE: Zip Code - o-76,0 DESCRIPTION OF WORK *OF UNITS X COST - TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6.00 = 2 URINALS X X $6.00 $6.00 =- = �� 3 3 TUBS SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT $6.00 SINKS LAVSIBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARYIMEAT $6.00 DISHWASHER • '' _ CLOTHES WASHER $6.00 = GARBAGE DISPOSAL $6.00 = WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE IF GAS, SEE MECHANICAL X $6.00 it FLOOR DRAINS AREA, CASE, COIL TRENCH, CONDENSATE • ” 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00" FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT PLUMBING, REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS $6.00 = G: , , 15 SEVVAGE EJECTOR GRINDER, SUMP PUMP $6.00 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER CROSS17 • • VACUUM BREAKER, CHECK VALVE, AND RP.B.P.D. FOR: VATS, TANKS, BOILERS 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 = 1,• 0 METHOD OF PAYMENT: `� CASH D CHECK Q VISA Q MASTERCARD \DATE: EXPIRES: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: `A - C) C7 BANKCARD. NUMBER: AUTHORIZED SIGNATURE: Zip Code - o-76,0