2004, 09-27 Permit App: BLD-04-07760 Plumbing Reversaln
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Project Address: ,E. //7/0 -
7 Owner: ,4 /<' n
Mailing Address: //'/G !/ //G y
Contractor:
Mailing Address:
Phone (Daytime Contact):
License #:
City
Sate Zip Code
Phone* 9 _170
City
i?/,
State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS X COST
-
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X $6.00
2
URINALS
X $6.00
3
TUBS
X $6.00
4
SHOWERS (PER TRAP"
BATH, STAB, ON-SITE BUILT
X $6.00
=
5
SINKS
LAVS1BASINS, BAR, FLOOR,
KITCI-EN, LAUNDRY, UTILFrY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X $6.00
6
DISHWASHER
X $6.00
7
CLOTHES WASHER
X $6.00
=
6
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,.
CONDENSATE
X $6.00
12
ROOF DRAINS/OVERFLOW DRAINS
X 56.00
1
13
FOUNTAINS, DRINKING
X $6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
/ X $6.00
p a
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
$6.00
11
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
-HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X $6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK ' '
VALVE, ANDRPBP.D. FOR
VATS, TANKS, BOILERS
'
X $6.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS • • - r outlet
NITROUS OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
•
METHOD OF PAYMENT: av
0CASH CHECK ❑ VISA ❑ MASTERCARD
4
DATE: / 1..2 7/0 -4 EXPIRES:
SUBTOTAL
//
6-r❑
' , 46----
PROCESSING FEE
$35..000
TOTAL PERMIT FEE DUE:
4/ ,
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: