2006, 05-16 Permit App: 06001868 Plumbing Reversal Permit Center
S kane' 11707 E Sprague Ave,Suite 106 PERMIT NUMBER: g
Sy Valley Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE
Community Development µRti�•spnkanevalleY.oro
Plumbing Permit Application ❑ Commercial Residential
SITE ADDRESS: CV CU t‘.1 LIAL$1L11
Building Owner
Name: eR A) 1 Phone: Fax:
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Address: City: State: Zip:
Contractor
Name: Phone:C1�� , q/ Fax:
Address: f'1fj Ad el: City-Lp State: Zip:
License No: City Business Lic:
Contact -'
Name: Phone:
DESCRIPTION OF WORK #OF UNITS X COST TOTAL 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 =
LAVSBASINS,BAR,FLOOR KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER X $6.00 =
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 =
AREA,CASE,COIL TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/D- -IN , NSTALLATION,ALTERATION,REPAIR
14 VENT,PLUMBING,f.- ' R a REVERSALS / X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE 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 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
ASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE: 7 �/
AUTHORIZED SIGNATURE:
REVISED 5/26/05
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\ Z-1 PROJECT NAME: WALNUT HOUSE TYPE: ru c L.. i2)11 ScMCN.`r
REF. DRAWING NO. 4.7 /5-6 REMARKS
FILE NUMBER: U _0 Z
Cc.) PARCEL: 4 5-/-74, 7O/ 9 6 I �` °•
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-I STREET: GJ A LJ t
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ADDRESS: A 6 0 2'