2004, 08-23 Permit App: BLD-04-07428 Plumbing Reversal PLUMBING PERMIT APPLICATION
�! City of Spokane Valley Community Development Department
BuildingDivision
Valle 1 1707 E. Sprague Avenue, Suite 106
„„,,,
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: e'_3 11 i.- Permit Use:
Owner: 4 f OA-t/,'c Phone (Daytime Contact):
Mailing Address: / I / City State Zip Code
Contractor: yet.- -)c ElcGivio n I., License#: Phone#: 2, 's 1—) -
is 9
Mailing Address: -I o 2) 1 i )7 12J sd k.#41,1E «e1 �' z i-z,
/ ity State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST - 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, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
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, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, .
X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS -
15 SEWAGE EJECTOR GRINDER,SUMP PUMP ,X ° $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER .
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 _=
METHOD OF PAYMENT: SUBTOTAL
0 CASH ❑ CHECK ❑ VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: ,
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: