2005, 01-21 Permit App: 05000197 Plumbing Reversal, ROWAnticipated start date
Location of property
Applicant Name
Celt 24 hours bell= nsp
Thom 509.688-0036 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Permit # PW
ROW CONSTRUCTION PERMIT
IL
Contractor's Name •
Address y /
Contractioi * floAg
hva
atVga garcElP'Q N (Provide site sketch or plan as necessary for clarity)
Sewer Connection E Driveway
Ell Gas I alation
Us.Sidewalk RepaldConstruction
ri Curb& Gutter
te sketch or p
Other
Pc Dimensions
BOndiifiSUral00 certification
's,ton np be on tlle,wih the - Bond e
Parmittee Signature
Hanby Vie CIV of Spokane IfaNeyip ctigs trs fee fortis pantie myaudit card.
Approved
Card f_______
rams of Hoer
Date Wit
Fees Paid$
(Application) (inspection)
In
each permit MI be
b additi th to the permitapplication
of $60.00 ler hour with aA�00 inspection hour) minim ermlttae
Mad m the permittee
signature on permit constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed) Date
.._.an "—A 'FII4r *# entered here
Sficrrr <xkne�
.000Valley
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 �. U 1'
OWNER: i
MAILING ADDRESS:
))"{ <\—
(µ'
PERMIT
USE:
PHONE (Daytime Contact):
(street)
&keo Lc)
(city/state)
CONTRACTOR: it _/_ C /_ _ m -h D)\)
MAILING ADDRESS:
(ZIP)
.11 gl 7 ue,tt�
(street)
(city/state)
LICENSE Y: i/ s Col '* jv23k P
PHONEY:
(ZIP) .
PLUMBING FIXTURES
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
DESCRIPTION
TOILETS
DETAILS
1 OF UMTS
URINALS
TUBS
WATER CLOSET, BIDETS
X COSTEQUALS
X
SHOWERS (PER TRAP)
SINKS
$6
X 1 $6
X
BATH, STALL, ON-SITE BUILT
DISHWASHER
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
$6
X I $6
X 1 $6
AMOUNT
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
X i $6
X I $6
X
ELECT. HOT WATER TANK
FLOOR DRAINS
X
NOTE: IF GAS, SEE MECHANICAL
FOUNTAINS, DRINKING
AREA, CASE, COIL, TRENCH, CONDENSATE
$6
$6
X I $6
X I $6
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
SEWAGE EJECTOR
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X I $6
X I $6
WATER USING DEVICE
GRINDER SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR
SWAMP COOLER
CROSS CONNECTION DEVICE VACUUM BREAKER CHECK VALVE, AND
RP.B.P.D. FOR VATS, TANKS, BOILERS
SPRINKLER SYSTEM
INTERCEPTORS
X I $6
X I $6
X I $6
MEDICAL GAS per outlet
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X 1 $25
X I $6
20 MISC. PLUMBING FIXTURE
NITROUS, OXYGEN
ETHOD OF PAYMENT
CASHVISA'
0 CHECK 0
ITh:
EXPIRES:
NKCARD NUMBER:
THORIZED SIGNATURE:
X I $6
X 1 $6
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
i
`J�