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2004, 08-09 Permit App: BLD-04-07294 Plumbing ReversalMETHOD 0 0 CASH CffYtN' �p�Ine .0•Mi11ey Plumbing Permit Application 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA.99206 509-688-0037 - Fax For Inspections, call 509-688-0054 PROJECT ADDRESS: ,ti, , ,_1(--,,, cs PERMIT USE: DETAILS # OF UNITS � OWNS jr a rit e_K1 PHONE (Daytime Contact): g 79,7 ---` AMOUNT NG ADDRE&: 9Ce c . .6,4 o4) (street) (city/state) (ZIP) WATER CLOSET, BIDETS / CO �R: /r 0 p (i ��n t /�) i rt ( LICENSE #: - MAILING AD DRESS:SS: 3 CI /o� S. da PHONE #: % ` c? c9 S 7 / 3 X $6 - (street) (city/state) (ZIP) ' TUBS PLUMBING FIXTURES DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 - 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL ON-SITE BUILT X $6 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 - 6 DISHWASHER X $6 - 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 - 10 ELECT. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X $6 - 13 WATER PIPING/DRAIN-IN WASH:, VENT, PLUMBING . REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS / X $6 - 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 - 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X $6 - 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X =' 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 - 20 MISC. PLUMBING FIXTURE X $6 - PAYMENT • • _ ,-,4_,-.' 'VISA- Vas SUBTOTAL: PLUS PROCESSING FEE: $35.00 IN CHECK ■ ■ -- ._> ''_ :. TOTAL PERMIT FEE DUE: L'/C/1 , DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: