2004, 10-22 Permit App: BLD-04-08004 Plumbing Reversal.00°\1.,
*lane
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BufdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
9GO ffitt; FOR INSPECTIONS, CALL (509) 688-0054
cProject Address: -�Permit Use:
Ph • ne D. ime Contact): qc--)`l -5(
Owner:
Mailing Address:
Contractor.
Mailing Address: :3 L%I of ,6". dl;(a
! City
License #: (7i'( i/-tc)
n Hl1 in0 )l) L9 97 f9
City Stade Zip Code
r
Phone #: 9'LI-S7/ 3
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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
LAVS/BASINS, 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
96.E
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
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
_
13
FOUNTAINS, DRINKING
X
$6.00
14
WATER PIPING/DRAI -IN WASTE,
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
/
X
$6.00
=
/49-61-0
VENT, PLUMB( G, REV'--- El ----
15
GRINDER, SUMP PUMP
X
$6.00
=
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 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
X
96.00
56.00
=
=
20
MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
0 VISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.0/0
TOTAL PERMIT FEE DUE:
ill [/
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: