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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,/