2004, 03-04 Permit App: BLD-04-03688 Plumbing Reversal 6 i 7 6 gy-
. . .
gin PLUMBING PERMIT APPLICATION
p^ ne City of Spokane Valley Community Development Department
alBuildingDivision
.0,00V
T,lev 11707 E. Sprague Avenue, Suite 106
�/" Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: ,,y ✓ Al , (/►/) L.bk/ Permit Use:
Owner: J_Iv� Kw ow L3 Phone (Daytime Contact):
Mailing Address: 1
City State Zip Code
Contractor: :///-a4-1 /'✓ / ZJXC,• License#: Phone#: .3
Mailing Address: FCL '3 < //';oZ SrokoA e- L,txz 9W//
Cit 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 LAYS/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, C X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
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
0 CASH ❑ CHECK ❑ VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
�
/.