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2003, 11-18 Permit App: BLD-03-03096 Plumbing Reversal , Scrrt<x�(�- wew,r 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone pone Spokane Valley,WA 99206 509-688-0037-Fax Valley For Inspections, call 509-688-0054 Plumbing Permit Application 30( (- PROJECT PERMIT ADDRESS: l I ()CI_ / ' Li) i I b u in USE: OWNER_% � P r-%` ,y ,,e y, PHONE(Daytime Contact): q (© _...5?(,) 9 MAILING AD/ DDD888ESS: __ _--)p 0 (,?at.„41.12 6,j a._ 99J6 6 (street) (city/state) (ZIP) C- :/ r. h ! I 1 /illi ,1 I A LICENSE#: MAILING ADDRESS: /�j��� ,f 3 q 3 L/ /D S- aCla/ '`- S PHONE#: q I - / l 3 fio Oa_ q_q (), (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 5 SINKS $6 LAVS/BASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 = RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER X $6 7 CLOTHES WASHER - 8 GARBAGE DISPOSAL X $6 X $6 9 WATER SOFTENER X $6 - = 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X 11 FLOOR DRAINS $6 AREA,CASE,COIL,TRENCH,CONDENSATE X 12 FOUNTAINS,DRINKING $6 - 13 WATER PIPING/DRAIN-IN , '+ _ a r.N,ALTERATION,REPAIR, X $6 _ WASTE,VENT,PLUMBING. R VERSALS y REVERSAL % 1 X $6 = () )14 SEWAGE EJECTOR GRINDER,SUMP PUMP 41` X 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 RP.B.P.D.FOR VATS,TANKS,BOILERS X $6 = 17 SPRINKLER SYSTEM 18 INTERCEPTORS X $25 = GREASE TRAP,SAND TRAP,CHEMICAL HOLDING TANK X $6 = 19 MEDICAL GAS per outlet NITROUS,OXYGEN 20 MISC.PLUMBING FIXTURE X $6 _ X $6 IOD OF PAYMENT SUBTOTAL: I ---•-;;; V SH 0 CHECK 0 0 I _ _f:J PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: V / � .) EXPIRES: 9 L/ :ARD NUMBER )RIZED SIGNATURE: