2005, 10-18 Permit App: 05003863 Sewer ReversalPermit Center
me 11707 E Sprague Ave, Suite 106
jValley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development www.spokanevalley.ore.com
Plumbing Permit Application
PERMIT NUMBER:
PERMIT FEE:
o Commercial Residential
SITE ADDRESS
Building owner
DESCRIPTION OF WORK
# OF UNITS
X
COST
Name:
TOTAL AMOUNT
1
Phone:
Fax
Address:
$6.00
=
City State
Zip
Contractor
X
$6.00
=
Name: C) C 04....1 V
Y u , ,.,, e
Phone:
Fax:
$6.00
Address: ! ' eiA E-
t r ct- t•
4
SHOWERS (PER TRAP)
City State
Zip
License No:
$6.00
=
City Business License No:
SINKS
Contact Ij `4,:, ,,,,a
CrCs,v-c_ i...`,
X
56.00
=
Name:
,.`
\
Phone:
X
$6.00
AUTHORIZED SIGNATURE:
c -
REVISED 8/26/05
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, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
56.00
=
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, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
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,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSALISYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
Card# EXPIRES:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
c -
REVISED 8/26/05