2004, 11-02 Permit App: BLD-04-08116 Plumbing ReversalSPlane
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Project Address:
Owner: (f�`r'` 1L 6d t) 771
Mailing Address: 9:2 0 6t
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
(C"Liit_LL421 Permit Use:
Phone (Daytime Contact):
r City
Contractor. 6 rP Lie J11 p (t,pi hdjo License #:
Mailing Address: :3 G/l d f% Dnpt) fi 976,3 I�
G City Sta a Zip Code
State Zip Code
Phone #: CO -/-57/ 3
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
*OF
UNITS
F
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
=
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
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN,IN-WASTE,
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
1
X
$6.00
=
VENT, PLUMBING, I ERSAL
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
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
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
X
$6.00
$6.00
=
=
18
INTERCEPTORS
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
, X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=•
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ID VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
/'/ 1, Ut
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: