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2004, 03-25 Permit App: BLD-04-03906 Plumbing Reversal*lane Valley Project Address: V. 3 ,4"o..c" Owner: Cr?/....t) M7 7 Mailing Address: _5,51171 to Contractor: 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 INSPECTIONS, CALL (509) 688-0054 Permit Use: Phone (Daytime Contact): /'(. 6, f0—;u City License #: Phone #: _gar? State Zip Code Mailing Address: State City BANKCARD NUMBER' AUTHORIZED SIGNATURE: Zip Code 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 LAVS/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/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 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 METHOD OF PAYMENT: ❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD DATE. EXPIRES: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: BANKCARD NUMBER' AUTHORIZED SIGNATURE: Zip Code