2003, Permit App: BD03-230 Plumbing ReversalS�1'd7
_' � FValley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call' 509-688-0054
?S 03-230
PROJECT /'
ADDRESS• 7, l6 .1 L. ,/35
PERMIT.
USE:
DESCRIPTION
JJ/a
OWNER: (4-479
4 t)4 4
PHONE (Daytime Contact): h z Q
'
COST
EQUALS
MAILING ADDRESS:
D I.
�1 / /
/..._..1 4
%
9i•
(-
(street) (dty/state) (ZIP)
$6
-
CO ER:)J ki _ ( tai 1 % /43
LL_l4 J i)i
LICENSE It:
URINALS
MAILING ADDRESS:
3 t/ J S. a S
‘-_Spn-ka ipu 13ct.
PHONE k:
qlc). i- 5-9/ 3
$6-
99 6 QL7
X $6
(street) (city/state) (ZIP)
4 SHOWERS (PER TRAP)
BATH, SPALL, ON-SITE BUILT
X $6 -
5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
PLUMBING FI
GARBAGE DISPOSAL
9 I WATER SOFTENER
X
$6
10 I ELECT. HOT WATER TANK
11 (FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
$6
12 ( FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
X 1 $6
X I $6
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
14 SEWAGE EJECTOR
15 I WATER USING DEVICE
IN
ALTERATION, REPAIR,
GRINDER, SUMP PUMP
I
X I $6
X
X
$6
$6
16 CROSS CONNECTION DEVICE
17 (SPRINKLER SYSTEM
18 (INTERCEPTORS
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, TROOPER, CARBONATOR,
SWAMP COOLER
X I $6
VACUUM BREAKER CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
X 1 $6
19 (MEDICAL GAS per outlet
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X 1 $25
X 1 $6
20 1MISC. PLUMBING FIXTURE
NITROUS, OXYGEN
MOD OF PAYMENT
=ASH 0 CHECK
E:
1111.1110111 41)
0 111115111111o
KCARD NUMBER.
EXPIRES.
-IORJZED SIGNATURE:
X 1 $6
X I $6
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE:
Lt
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
-
2
URINALS
X
$6-
3 TUBS
X $6
4 SHOWERS (PER TRAP)
BATH, SPALL, ON-SITE BUILT
X $6 -
5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X $6 -
6 DISHWASHER
X $6
7 CLOTHES WASHER
X cc
GARBAGE DISPOSAL
9 I WATER SOFTENER
X
$6
10 I ELECT. HOT WATER TANK
11 (FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
$6
12 ( FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
X 1 $6
X I $6
13 WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
14 SEWAGE EJECTOR
15 I WATER USING DEVICE
IN
ALTERATION, REPAIR,
GRINDER, SUMP PUMP
I
X I $6
X
X
$6
$6
16 CROSS CONNECTION DEVICE
17 (SPRINKLER SYSTEM
18 (INTERCEPTORS
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, TROOPER, CARBONATOR,
SWAMP COOLER
X I $6
VACUUM BREAKER CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
X 1 $6
19 (MEDICAL GAS per outlet
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X 1 $25
X 1 $6
20 1MISC. PLUMBING FIXTURE
NITROUS, OXYGEN
MOD OF PAYMENT
=ASH 0 CHECK
E:
1111.1110111 41)
0 111115111111o
KCARD NUMBER.
EXPIRES.
-IORJZED SIGNATURE:
X 1 $6
X I $6
SUBTOTAL:
PLUS PROCESSING FEE: I $35.00
TOTAL PERMIT FEE DUE:
Lt