2004, 11-08 Permit App: BLD-04-08129 Plumbing Reversal, FixturesPLUMBING PERMIT APPLICATION
ne 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
Project Address: gl/ /ti C6 Y7 5 S �' Permit Use:
1
Owner: g re -i h -e c c/e4.� Phone (Daytime Contact): % S Vn— 376,5-(7/
Mailing Address: 0 // ?rvc•Y�sS LA) A- 7 9z/,
-- City State Zip Code
License #: Phone #:
Contractor: 8e / (
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: /G�'
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
$6.00
=
( - 1 C
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6.00
=
L - V
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP/CULINARY MEAT
/
X
$6.00
=
c -
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
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 DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
n
METHOD OF PAYMENT:
0 CASH 0 CHECK
ria -m•
0 VISA 0 MASTERCARD
EXPIRES: _
40SUBTOTAL &
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
\
'S-7 ,7° b 6
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: /G�'