2004, 03-31 Permit App: BLD-04-03948 Plumbing Reveresal I.
PLUMBING PERMIT APPLICATION
Spokane011A111City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: /006 ii /2.cio /,ti Permit Use:
Owner: t,i4-k,r 16,i,/2_. Phone (Daytime Contact):
Mailing Address: / / / /24 -J 4.-4
City State Zip Code
Contractor: A6/-1 c 6",4,„4,4,1...„ License#: *e2 i.-4 Phone#: 2 i-43 $P
Mailing Address: 302/ `/ 44, /Z�( l`� l' ,F z....-.1 2e-; �.,-t_Ci'City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = 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 LAYS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
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, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00
VATS,TANKS,BOILERS ,
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: