2004, 10-25 Permit App: BLD-04-08032 Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
• Spokane Valley, WA 99206
- I
Project Address: I ON) CO c Permit Use:
Owner: /� (M Q/�-1 (� tiv- Phone (Daytime ntact): gq — 7c/ 3
Mailing Address: I�)n° 0' C \// Z/lk C3i%x �t F� A .- g17,1,6�o
City v State Zip Code
Contractor: License #:
Mailing Address:
Phone #:
City
State
Zip. Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTOR 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
$600
=
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
=
%l
14)
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, 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
=
21
PRIVATE SEWAGE DISPOSAIISYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: