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2004, 08-02 Permit App: BLD-04-07199 Plumbing Reversal
Spokane 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call509-688-0054 Plumbing Permit Application PROJECT ADDRESS: lb.. i PERMIT USE: OWNER: S d / dPHONE (Daytime Contact): MAILING AD RESS: �� // 7 /L) ---L." k 1 ' 6 („p , /1) ia--Y0(6 (street) (city/state) D / (i Yr� (� % it ( l (ZIP) LICENSE #: ' ^ COERY N Clip MAILIING ADDRESS: ,3 N /D S. C �m Ail ryi<4.,K.$). 0 ciL PHONE #: — CIS ( �; 3 q96,_ (street) (city/state) (ZIP) • PLUMBING FIXTURES DESCRIPTION 1 TOILETS 2 URINALS 3 TUBS DETAILS WATER CLOSET, BIDETS 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT 5 SINKS 6 DISHWASHER 7 CLOTHES WASHER 8 GARBAGE DISPOSAL 9 WATER SOFTENER LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- X $6 RAY, FOOD, PREP/CULINARY/MEAT # OF UNITS X COST EQUALS AMOUNT X $6 - X $6 - X $6 X $6 10 ELECT. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE 12 FOUNTAINS, DRINKING 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING . REVERSAL REVERS LTERATION, REPAIR, 14 SEWAGE EJECTOR GRINDER, SUMP PUMP 15 WATER USING DEVICE 16 CROSS CONNECTION DEVICE 17 SPRINKLER SYSTEM 18 INTERCEPTORS MEDICAL GAS per outlet MISC. PLUMBING FIXTURE )D OF PAYMENT ❑ CHECK ❑ MiMiVISA' URD NUMBER: ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, X $6 SWAMP COOLER $6 X $6 - X $6 X $6 - X $6 X $6 X $6 - X $6 X $6 VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR VATS, TANKS, BOILERS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK NITROUS, OXYGEN X $6 - $25 EXPIRES: UZED SIGNATURE: SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: �lr