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2005, 03-18 Permit App: 05000821 Plumbing Reversal, Fixtures PLUMBING PERMIT APPLICATION Community Development Department Building Division Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106 For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206 • Project Address: 10/1 -1/4,'1 ,0<U,' Permit Use: • Owner: Acek Phone (Daytime Contact): Mailing Address: . City State Zip Code • Contractor: Vt1Lr 4.-t) /U CA) 1CCcA/416j 5License#: (,Ul,GrUi�L h•; Phone#: c y Mailing Address: (/(08 7 5C= ( 65-1-L,c {t© ( t c cZ City State Zip Code 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,ONSITE BUILT X $6.00 = • LAVS/BASINS,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 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 = 'ROOF DRAINS/OVERFLOW 12 DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, ^^ 14 VENT,PLUMBING,REVERSAL .REVERSALS I 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, 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 520.00 = _ INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = • SUBTOTAL METHOD OF PAYMENT: • 0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE .$35.00 • DATE: EXPIRES: TOTAL PERMIT FEE DUE: • BANKCARD NUMBER: AUTHORIZED SIGNATURE: •