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2005, 06-22 Permit App: 05002116 Plumbing Fixtures, Reversal
PLUMBING PERMIT APPLICATION Community Development Department ,rte Building Division Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106 4/ ley For Inspections, Call (5(3) 683-0054 Spokane Valley, WA 99206 . l (,"t6771 0Z( ICf Project Address: 'd.J-� /lam � Permit Use: Owner. te_Qi,V 1 Phone(Daytime Contact): Mailing Address: litYl.A E_ ((�� City State Zip Code Contractor. -�-1-i- LJ i?1/4-iJCs2_t t"Lmi .00,4Lieense#: /f1xj,¢11/4.?tP(,4hone#: 3 22 -6 11 ) Mailing Address: City State Zip Code DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT = °`—' $6.00 (� 1 TOILETS WATER CLOSET,BIDETS 1 X 2 URINALS X $6.00 = 3 TUBS X $6.00 = / 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6.00 = (O Cr."----- LAVS/BASINS,BAR,FLOOR,KITCHEN, 5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, / X $6.0D = ,✓ X-RAY,FOOD,PREP/CULINARY MEAT Com/ 6 DISHWASHER X $6.00 = / 0±2...._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 = lb ROOF DRAINS/OVERFLOW 12 DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 = WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, 06 14 VENT,PLUMBING,REVERSAL REVERSALS ( X $6.00 = 15 SEWAGE EJECTOR GRINDER,SUMP PUMP ik X $6.00 = ((( 7 1:1------ ICE AN/OR COFFEE MAKER,HOSE BIB, 16 WATER USING DEVICE STEAMER X $6.00 = PROOFER,CARBONATOR,SWAMP COOLER VACUUM BREAKER,CHECK VALVE, 17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 = GREASE TRAP,SAND TRAP, 18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = MISCELLANEOUS PLUMBING 20 FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = SUBTOTAL /C73D(- METHOD OF PAYMENT: 0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE (/35.00~ �_1 \1 DATE: EXPIRES: TOTAL PERMIT FEE DUE: '7 )0� BANKCARD NUMBER: -. • AUTHORIZED SIGNATURE: