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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: