2004, 09-15 Permit App: BLD-04-07653 Plumbing Reversal4000VaIley
Project Address: ®/,?O C/' j % 0
Owner:
Mailing Address:
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
0
Contractor. 06 P C1,e, pal.;
Mailing Address:
City
License #: U7t i
State
Phone #:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
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, ONSITE BUILT
X
$6.00
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
$6.00
^I
=
6
GARBAGE DISPOSAL
X
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- TE,
VENT, PLUMBIN , R t�lERS(t�
INSTALLATION, ALTERATION.
REPAIR, REVERSALS
GRINDER, SUMP PUMP
•
X
X
$6.00
$6.00
=
=
15
SEWAGE EJECTOR
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 RP.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
X
$600
56.00
=
=•
_
20
MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
0 CASH I_k CHECK ❑ VISA Q MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
//�
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code