2004, 07-12 Permit App: BLD-04-07048 Plumbing ReversalValley
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Project Address: AO' `'4 i,' i/ ..J
Owner: ' (� Atc ssuf
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Mailing Address: /o/`/ N t , ((.✓ to,
Contractor. ¶4-J41-7 PLvr4tl�tr�
Mailing Address:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
License #:
City State Zip Code
Phone#: 92-L-15gJ
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATUREi / 4/4
Zip Code
DESCRIPTION OF WORK
*OF
UNITS
X
COST
•
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
58.00
=
2
URINALS
-
X
58.00
=
3
TUBS
X
$8.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
58.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILFY,
JANITOR PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
58.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR
VATS, TANKS, BOILERS
X
58.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$8.00
=
METHOD OF PAYMENT:
(erCASH ❑ CHECK 0 VISA ❑ MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATUREi / 4/4
Zip Code