2004, 09-29 Permit App: BLD-04-07804 Plumbing Reversal •
PLUMBING PERMIT APPLICATION
e City of Spokane Valley Community Development Department
BuildingDivision
,R lei 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
do,
Phone: (509)688-0036;Fax: (509)688-0037
/1102
/ FOR INSPECTIONS, CALL(509)688-0054
/
Project Address: L/�6/ �• 3( / f/ Permit Use: .
Owner: A / eA Hoi R, hoi to C / Phone (Daytime Contact):
Mailing Address: PI) c/ . 5/.rmd 4Ac/G
/ ' City State Zip Code
Contractor. 6'P L �a �(��( h. i License#: An il-P_ Phone#: 9D-/- 7
Mailing Address: 3 I of „5". afiiii o H1 in0t)/9- 941(7.:3 -
L City lit 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,ONSITE 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 =
e GARBAGE DISPOSAL X $6.00 1 .
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/D ASTE, INSTALLATION,ALTERATION, X $6.00
VENT, PLUMBI�E�E� REPAIR,REVERSALS / 4 --L '6-1
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.BP.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 0 MASTERCARD PROCESSING FEE J/$35.00
�7
DATE: EXPIRES: TOTAL PERMIT FEE DUE: L!(/
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: