2004, 10-25 Permit App: BLD-04-08031 Plumbing ReversalSTiolane
do,Valley
Project Address:''q/ c?
Owner: .�' 1 a, /- /)/ <-
Mailing Address: / / /
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):
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City
Contractor Y' Ly top V1i .mbWk1 License #: ori
Mailing Address: :1 e%19 ,5*. n H4 AID 6i) / `T%(),3
City Sta e
State Zip Code
Phone #: Glo-/-37/ 3
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, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
8
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$8.00
=
8
GARBAGE DISPOSAL,
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
40
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-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAJ , REVEJ SALS
/
X
$6.00
$6.00
=
=
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SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
18
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 R.P.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
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH ❑ CHECK
nerc•
❑ VISA ❑ MASTERCARD
FXPIRES*
SUBTOTAL
PROCESSING FEE
$ 5.0/0
TOTAL PERMIT FEE DUE:
("//. ! J7)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code