2004, 10-18 Permit App: BLD-04-07947 Plumbing ReversalPLUMBING 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): C/ c / 6c3
Project Add ss:
Owners _,
Mailing Address:
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tate
Contractor. 6,P I_ f nil 19 ritt /-4104iYA License #: n ,..-/-/-P__
Mailing Address: 0 )a .S• dc/a nhf14 b/) 996,3
St
7 a e
City
Zip Code
Phone #: 9'�/- / 3
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
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, ON-SITE BUILT
X
$6.00
'-
5
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
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/ORA! - TE,
VENT, PLUMB! , R ERSAL)
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=/
=
=
/_P - C/ l/
—
15
GRINDER, SUMP PUMP
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
X
$6.00
$6.00
SEWAGE EJECTOR
16
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND RP.B.P.D. FOR
VATS, TANKS, BOILERS
X
56.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
0 VISA 0 MASTERCARD
EXPIRES: --
SUBTOTAL
PROCESSING FEE
$35.00/
TOTAL PERMIT FEE DUE:
0 )
% /. �/ Z)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code