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2003, 05-21 Permit: BD03-424 Plumbing Reversal crTc �4 11707 East Sprague Avenue,Suite 106 509-688-0036 - ����ePhone Spokane Valley,WA 99206 509-688-0037-Fax ,,.o.i 'Mil1ey Plumbing Permit Application :� � PROJECT PERMIT ADDRESS: /4,,62/ ivy (ti p'f (� )f a_r_( USE: OWNER /1n.4 47,,ii -1.-,.-0 C PHONE(Daytime Contact): MAILING ADDRESS: �� ' -� 3 (street) (city/state) (ZIP) CONTRACTOR / ,� LICENSE#: CcvvRc!.41(AO Y' C::.;vru C fth CCd U�'CC /F/ MAILING ADDRESS: �^ iP 1_ es , PHONE#: s-1'` - Sea y- ,s—c/0,5— . _c_,5 (street) (city/state) (LW) �' J W)) PLUMBING FIXTURES DESCRIPTION 2,CA ` �� DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS 2 URINALS X $6 - -\, 3 TUBS X $6 _ (PER TRAP) X $6 4 SHOWERSY x BATH,STALL,ON-SITE BUILT X $6. l 5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO;X- X $6 RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER 7 CLOTHES WASHER X $6 8 GARBAGE DISPOSAL X $6 • 9 WATER SOFTENER X $6 - 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 - 11 FLOOR DRAINS X $6 AREA,.CASE,COIL,TRENCH,CONDENSATE ' 12 FOUNTAINS,DRINKING X $6 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, X $6 - _.WASTE,VENT,PLUMBING REVERSALS . REVERSAL / X $fi - e 6P� 14 SEWAGE EJECTOR GRINDER,SUMP PUMP / 15 WATER USING DEVICE X $6 - 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 ._ X $2,5 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL ft • HOLDING TANK X $6 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 ` 20 MISC.PLUMBING FDCTURE X $6 EiOD OF PAYMENT SUBTOTAL: ,�Y.,...... Cp, e2 CD iiiiiii VISA- • rer 'ASH . 0 CHECK 0 0 �___;_. _ PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: GF f EXPIRES: CARD NUMBER: ORIZED SIGNATURE: