2004, 08-13 Permit App: BLD-04-07368 Plumbing Reversalal'4 c1C �e ��
Spokan
,,,,.•Walley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: 301 r�
OWNER: inl 0.QSP
MAILING ADDRESS:
(street)
PERMIT
USE:
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(city/state)
CONTRACTOR // / S Coi -yct_c-fig 0,11MAILING ADDRESS: `-U
PHONE (Daytime Contact): 9 a-7- Fs aa3
ZIP)
LICENSES: J S C Ol�,{. 4f j...2
3 k
PHONE 1: I
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(street)
(city/state) �' q 9�e
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PLUMBING FIXTURES
1
DESCRIPTION
TOILETS
DETAILS
it OF UNITS
WATER CLOSET, BIDETS
X COST EQUALS
2
3
4
5
6
7
8
9
URINALS
TUBS
X I $6
X $6
AMOUNT
SHOWERS (PER TRAP)
SINKS
X I $6
BATH, STALL, ON-SITE BUILT
X i $6
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X 1 $6
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
10
11
12
13
14
15
16
17
18
19
20
WATER SOFTENER
ELECT. HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
X J $6
X ' $6
X I $6
X $6
X $6
X I $6
WATER PIPING/DRAIN-W
WASTE, VENT, PLUMBING.
REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER, SUMP PUMP
CROSS CONNECTION DEVICE
SPRINKLER SYSTEM
INTERCEPTORS
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X I $6
X I $6
X J $6
X $6
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X I $6
MEDICAL GAS per outlet
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X l $25
X $6
MISC. PLUMBING FIXTURE
NITROUS, OXYGEN
X $6
X I $6
TROD OF PAYMENT
CASH ❑ CHECK ❑
CE:
EXPIRES:
4KCARD NUMBER:
-HORIZED SIGNATURE:
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:- I 1 I ..o