2004, 10-04 Permit App: BLD-04-07828 Plumbing Reversal 1 ,
PLUMBING PERMIT APPLICATION
Y City of Spokane Valley Community Development Department
�e BuildingDivision
Va!'ey 11707 E.Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: `r � • [.tom r /gdti
Permit Use:
Owner: _ ) d h A L LA j'VlI b r S Phone (Daytime Contact): 9 3 -.3-a).?-0
Mailing Address: /1f / SGC ,t�6 '�'r / Q
/ ' City State Zip Code
Contractor. 6,,c2 Lk imp l(� h6jvl License#: Phone#: q;/- /3
Mailing Address: 43 L/)a ,5"*. d( if4c)/9- 99tl3 7 11)
L 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 kAVS/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 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION ON, X $6.00 =
VENT, PLUMBING,REVERSAL REPAI EVERSALSJ I & 6e3 I
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 RP.B.P.D.FOR X r $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 56.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = •
METHOD OF PAYMENT: SUBTOTAL
0 CASH Q CHECK ❑ VISA Q MASTERCARD PROCESSING FEE $35..00/
DATE: EXPIRES: TOTAL PERMIT FEE DUE: C�/f 0 7)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: