2004, 11-02 Permit App: BLD-04-08115 Plumbing Reversal, Fixtures I •
PLUMBING PERMIT APPLICATION
SfiCity of Spokane Valley Community Development Department
� , BuildingDivision
Bey 11707 E.Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS,CAL (509))6�688-0054� �
•Project Address: �6 ( 3 F. 2 N6 �� Permit Use: ` , �+
Owner: . ':.1A �- -- 1/�- tr.8. Phone (Daytime Contact):
Mailing Address: ( ii .• e3 pt. So` _
•
City State Zip Code
Contractor. License#: . Phone#:
Mailing Address:
City State Zip Code
*OF. TOTAL
DESCRIPTION OF WORK MITTS • X : COST= ACO�MOUNT •
1 TOILETS WATER CLOSET,BIDETS X $6.00 -(30
2 URINALS X : $6.00 = -
3 TUBS • X $6.00 . '-i •
4 SHOWERS(PER TRAP" BATH,STALL,ON (0-00
SITE BUILT 1 X $6.00 =
' 5 SINKS LAVS/BASINS,BAR,FLOOR,
' KITCHEN,LAUNDRY,UTILITY, i ' X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
• PREP/CULINARYIMEAT - •
_,—r
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER • X $6.00 =
B 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 • l X $6.00 L.
'
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATIO. •TION, ( X $6.00 = (_60
•
VENT, PLUMBING,REVERSAL REPAI. .
I SEWAGE EJECTOR GRINDER,SUMP PUMP ;X $6.00 = '
WATER USING DEVICE ICE AN/OR COFFEE MAKER, '
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR.SWAMP COOLER
CROSS CONNECTION DEVICE VACUUM BREAKER,-CHECK ' '_
VALVE,ANDRP.B.P.D.FOR X $6.00
VATS,TANKS,BOILERS
INTERCEPTORS • GREASE TRAP,SAND TRAP, X $6.00 =
• CHEMICAL HOLDING TANK
111 MEDICAL GAS(per'outlet) NITROUS,OXYGEN _ X $6.00
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = /e• 7�
METHOD OF PAYMENT: • SUBTOTAL 2.L 0•- 0
❑ CASH 0 CHECK ❑VISA ❑ MASTERCARD PROCESSING FEE $35.00/ /�
DATE: EXPIRES: TOTAL PERMIT'FEE DUE: "I�0.0 L/
BANKCARD NUMBER �1 I c—
AUTHORIZED SIGNATURE: U