2004, 11-15 Permit App: 04009071 Plumbing Reversalc I (
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):
Project Addrftss: a /O
Owner:
Mailing Address: /it
City
Contractor. 6,o L) 1111 pf"/t p -n h6jt� License #: (74 /'.p Phone #: q�/-�/ 3
Mailing Address: :3 /) a �. d 'nO H/ ,n0 61) r9- 99 i1
/ City Sta a Zip Code
State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS •
X
COST
-
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
TUBS
X
X
$6.00
$6.00
=
=
3
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
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00•
=
10
ELECTRIC HOT WATER TANK
NOTE (F 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 TION,
REP R
GRINDER, SUMP PUMP
(
X
X
$6.00
$6.00
=
,c . 7
15
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 RP.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
$6.00
$6.00
=
=•
20
MISCELLANEOUS PLUMBING FIXTURE
METHOD OF PAYMENT:
0 CASK Q CHECK
M
Q VISA Q MASTERCARD
EXPIRES:
SUBTOTAL
PROCESSING FEE
35.00 _
TOTAL PERMIT FEE DUE:
7. c/-''/
Zit �
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: