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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: