2005, 06-13 Permit App: 05002012 Plumbing Reversal, ROWrti� oI�
Sl oka. e
Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 bUy-orso-UU3o - rnoile
Spokane Valley, WA 99206 509-688-0037 - Fax
For ..Inspections, call 509-688-0054
PROJECT
ADDRESS:
OWNER:J dQ�/
MAILING AD RESS: ✓�
(street)
!,
city/state)
PERMIT
USE:
PHONE (Daytime Contact):
04 � 1 ZF92/4
J )
(
CONTRACTOR: j e / , Co' 'fircz_c- 013
MAILING ADDRESS:
LICENSE #: 1-' s C 0 ' j.„.2 3 /t. f"
PHONE t:
.1/ gl7 u(LAleyi,A,a s,,0 �9 6
1
(street)
DESCRIPTION
TOILETS
2
URINALS
3
TUBS
4
SHOWERS (PER TRAP)
5
SINKS
6
DISHWASHER
7
CLOTHES WASHER
8
GARBAGE DISPOSAL
9
WATER S01• t E,NER
10
11
(city/state)
PLUMBING FIXTURES
DETAILS
WATER CLOSET, BIDETS
BATH, STALL, ON-SITE BUILT
ELECT. HOT WATER TANK
FLOOR DRAINS
12
13
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING .
REVERSAL
14
SEWAGE EJECTOR
15
WATER USING DEVICE
16
CROSS CONNECTION DEVICE
17
SPRINKLER SYSTEM
18
INTERCEPTORS
19
MEDICAL GAS per outlet
20
MISC. PLUMBING FIXTURE
4ETHOD OF PAYMENT
] CASH 0 CHECK 0
>ATE:
ANKCARD NUMBER: _—
UTHORIZED SIGNATURE:
VISA... .
11)1126211
LAVS/BASINS, BAR FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
NOTE: IF GAS, SEE MECHANICAL
(ZIP) •
# OF UNITS
X
X
X
X
X
X
COST
$6
$6
$6
56
$6
EQUALS
AMOUNT
AREA, CASE, COIL, TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
EXPIRES:
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
$6
$6
56
56
$6
$6
$6
$6
56
56
$6
525
$6
$6
$6
SUBTOTAL: / �
PLUS SSING FEE: $35.00
TOTAL PERMIT FEE DUE:
1
Call 24 horns botioco inspectioaroquiraf
Phone 509.688-0036 Fax 509.688-0037
1
DEPARTMENT OF PUBLIC WORKS
Anticipated start date
ROW CONSTRUCTION PERMIT
Location of property /.:,/t2 �,
dress/Parcel #, if available)
Applicant Name 0/9-71, A/h40
Address /3..V40 �%�� Phone S 2-/ ~ 1
Contractors Name 114 S g St Y �C+L. fl
Adder // g / 7 If Palk , way Piwne ,91.74
Contractor's Regi..}
Permit # PW
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
CDriveway
flGasksOfl instaliation
SidewalicRepaidConstruction
E__Sowor Connection
nC& r
Ca,bie/Condtdt
Other
Pavement Cut? Dimeasions
1 SPECIAL CONDITIONS:
BOIldiffISUMEICO certification must beo,nMe WW1 the City. Bond *
Parmittee Signature Approved
thereby authorize the Cit/ of Spokane Valley b theme rte fee fortis perm b ray audit cad.
Card f Expiration Dais
Naas of Holder
Fees Pald$
(Application) (inspection)
In addition to the permit application fes of $16.00 or $25.00, inspection on each permit villi be
signature uon pews* constitutes an agreement these tonna and hour)
provisions.
nhnum. Pemilttae
Work completed satisfactorily (Signed) Date
Date
inti
.. .. . ..,..+ ___as* i- — l+wn ikr.t er...AHna TielsAt it entered here