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2004, 07-28 Permit App: BLD-04-07181 Plumbing Reversal
*acme 40.0 Valley Plumbing Permit Application 11707 East Sprpgue Avenue, Suite 106 509-688-0036 - Phone Spokane Valley, WA 99206 509-688-0037 - Fax For Inspections, call 509-688-0054 PROJECT ADDRESS: 1 q 1 (0 4 (' �f 1 , l / o) /- I\ 111 PERMIT SE: DETAILS V OWNER: o -- l 0 AVIS PHONE (Daytime Contact): COST MAILIN DDRESS: I R I La ()1941`P LA) � �,� (,�a:-i9,g (street) (city/state) (ZIP) TOILETS COIjI�'RA QR: /� , p ip ! �1 IV,'n ( ( LICENSE #: $6 MAILING ADDRESS: .3L//a S.dci� PHONE #: POI -3-7/ URINALS (street) (city/state) (ZIP) , PLUMBING FIXTURES METHOD 0 0 CASH DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION DETAILS # OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 - 2 URINALS X $6 - 3 TUBS X $6 - 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT X $6 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 6 DISHWASHER X $6 - 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 - 10 ELECT. HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6 - 12 FOUNTAINS, DRINKING X $6 - 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING . REVERSAL INS - TIOTTjALTERATION, REPAIR, / X $6 - REVERSALS _-- _ -- 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER X $6 - 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS X $6 - 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X - 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 - 20 MISC. PLUMBING FIXTURE X $6 .- PAYMENT 2 CHECK - VISA- gas �__ ..: SUBTOTAL: SUBTOTAL: PLUS PROCESSING FEE: $35.00 ■ ■ TOTAL PERMIT FEE DUE: e?/ /j DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: