2004, 07-22 Permit App: BLD-04-07156 Plumbing Reversal M
0"PikSPLUMBING PERMIT APPLICATION lane
City of Spokane Valley Community Development Department
BuildingDivision
Eley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
C FOR INSPECTIONS, CALL(509)688-0054
Project Address: )J , (�D S S,IA 01) IZ LA-0 b Permit Use:
Owner: IA\tX17 tU fl-IZ1.-1/104;,TOO Phone (Daytime Contact):
Mailing Address: N 13 os- S lA N'DE[?LI\K)-16
City State Zip Code
Contractor: RC_(An t License#: Phone#: SC /Z?4?-Dlo`y/
Mailing Address: 3 Zi tv Lt Ly
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST 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, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
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, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
/13 FOUNTAINS,DRINKING X $6.00 , =
,V// 14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, )c X $6.00
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS �%)
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 -=
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D_FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X, $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: