2004, 07-15 Permit App: BLD-04-07073 Plumbing Reversal J
- PLUMBING PERMIT APPLICATION
Spoorka<\
City of Spokane Valley Community Development Department
BuildingDivision
Va
?` 11707 E. Sprague Avenue, Suite 106
�p� !;,` 0 fSpokane Valley, WA 99206
4,„00
liv Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: 16 70 b L . L )P. 1 ( esi L�( Permit Use:
Owner: J Phone (Daytime Contact):
Mailing Address: 1 7 n b C= Lt..)e-k l e s j State Zip Code
City _
Contractor: .
' C_nu 6ZC\r\.- ; e'-c _-Con f. License#: Phone#: 32 L{ Sy '
Mailing Address: Iqoig C. J+cg �*ocQ, b3,-,City 990R-.)
e
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 =
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, 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, i X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS t
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
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: