2004, 12-10 Permit App: 04009366 Plumbing Reversal PLUMBING PERMIT APPLICATION Community Development Department
IA ii Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
dina1 For Inspections, Call (509) 688-0054 Spokane (Valley, WA 99206
Project Address: /414-1 i WtAiln Permit Use: ski .e:
Owner: / eir-4- .144/ 1 b 1-- Phone (Daytime Contact):
Mailing Address: Pit( !l/ r#41 I hum.
City State Zip Code
Contractor: 'l'e 41 ac/rwbie, License#: Phone#: %2.2-^/cY
Mailing Address:
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 =
LAYS/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,ALT •k REPAIR,
14 VENT,PLUMBING,REVERSAL / 'a 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,
16 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 $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
"aASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: /)c4Y,/