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2003, 04-09 Permit App: BD03-056 Sewer Reversal
' (�cm( Iw o 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone Spokane Spokane Valley,WA 99206 509-688-0037-Fax • .0,00Valley Plumbing Permit Application cA) O3— 031Q PROJRCT /a/7 / n` 1 )(eC 1 Q M USE: pi � ADDRESS: U V J lu OWNER: / ` / 5S( S'c r0`;,e 6 PHONE(Daytime Contact): 76/_ 6/03 MAILING ADDRESS: / OI / 7` /iii it) ' Uif 1-((—/ .6/. / .e, can qc( -2/0 (street) (city/state) (ZIP) CONTRACTOR: D`O ') p7 . r LICENSE#: V v � C-� MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) PLUMBING FIXTURES 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 LAVSBASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 = RAY,FOOD,PREP/CULINARY/MEAT 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 s 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, WASTE,VENT,PLUMBING REVERSALS X `X $6 - UZ.� REVERSAL / ` 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 = 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, STEAMER,PROOFER,CARBONATOR, X $6 = SWAMP COOLER 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 = R.P.B.P.D.FOR:VATS,TANKS,BOILERS 17 SPRINKLER SYSTEM X $25 = 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 = HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 = 20 MISC.PLUMBING FIXTURE X $6 - SUBTOTAL: METHOD OF PAYMENT MEMVISA • !ast, PLUS PROCESSING FEE: $35.00 ❑ CASH . 0 CHECK 0 NM= 0 L__.. ....__.2.-: TOTAL PERMIT FEE DUE: Li` OD DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: