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2005, 09-30 Permit App: 05003607 Sewer Reversal
Permit Center cm cr 11707E Sprague Ave,Suite 106 ,,. 3(D(17 . Vall PERMIT NUMBER: Spokane Valley,WA 99206 (509)688-0036 FAX:(509)688-0037 PERMIT FEE: l . Community Development www.spokanevalley.ore.com Plumbing Permit Application- // � El Commercial Mi 'esidential SITE ADDRESS: /30Ci .51 iQJc i- (f/ ( SI?UK(Gr-€f &%/4 1`Izod Building owner d ' ' SJ -4�2Z-1211 Name: -0—atn I�c]:vizPhone:X30 -Zl1 SIr32 f Fax: O/—W/—.21OJS� Address: 13o9 A. if- yr,JOt.fi, C, r City: ipid ,i,f State:WA- Zip: gc/Z.06 /` Contractor 2Sid€ri7' 0�crs2t� Name: Phone: Fax: Address: City: State: Zip: License No: City Business License No: 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 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 = ROOF DRAINS/OVERFLOW 12 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, 17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,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 MISCELLANEOUS PLUMBING 20 FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE ❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD $35.00 Card# EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05