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2008, 08-14 Permit App: 08003170 Plumbing Reversal Permit Center Sc�rx or 11703 E Sprague Ave,Suite B-3 poka`nee' Spokane Valley,WA 99206 PERMIT NUMBER: �t �� Val1eyR (509)688-0036 FAX:(509)688-0037 PERMIT FEE: C� ` ` ' www.s okanevalley.ory 1 Community Development Plumbing Permit Application d n Commercial Residential SITE ADDRESS: 52 3 A) 5ALSC C(V t rZed Building Owner Name: rt l A w o pr Phone: Fax: Address: 5 Z 3 1Ve 1 S por 4 N 4-1" City: State: Zip: Contractor Name: FC L !:X�i�✓A I�N/_ Phone: 75I- QD,S-Q Fax: �+ 1 Address: 680fv s L oICL fed. City: (.1 ce,-NJACiz s State: ,4. Zip: _1 q©�47 License No: /1 C M EEC" 59 la 3LCity Business Lic: Contact Name: Phone: 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 = LAYS/BASINS,BAR,FLOOR,KITCHEN, 5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = 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 = AREA,CASE,COIL,TRENCH, 11 FLOOR DRAINS CONDENSATE X $6.00 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 = WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, 14 VENT,PLUMBING,REVERSAL REVERSALS I X $6.00 = 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = ICE AN/OR COFFEE MAKER,HOSE BIB, 16 WATER USING DEVICE STEAMER X $6.00 PROOFER,CARBONATOR,SWAMP COOLER VACUUM BREAKER,CHECK VALVE, AND R.P.B.P.D.FOR: VATS,TANKS, 17 CROSS CONNECTION DEVICE BOILERS X $6.00 = GREASE TRAP,SAND TRAP, 18 INTERCEPTORS 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 = SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE ❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00 Card# VIN: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05