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2006, 01-23 Permit App: 06000168 Sewer Reversal
sea.° \oar., Permit Center no a 11707E Sprague Ave, S9fte'I 06 Spokane Valley,. WA J9206 (509)688-0096 PAX: (509)688-0037 Community Development www.sookanevallev.ore.corq Plumbing Permit Application ❑ Commercial PERMIT NUMBER 0 /lle 8 PERMIT FEE: tit" esidential SITE ADDRESS: S 109 e AUTHORIZED SIGNATURE: REVISED V26/03 DESCRIPTION OF WORK Building owner . , . .. ...., , . COST Name: /X(1— t3 ✓` Phone: Fax: Address: C/ Oct E. $s City: State: zip: -Cooti•actnr.. itk r.l.. GI I,uwt:j.w5.. . • �' ' ''% :".. �• .: ? 1 , = Name: / Phone: ... . Address: City : State: Zip: License No: City Business License No: Contact: .,. : :. �.� vm.a4l,44wt Name: -- 'i . Nj Phone: 5 Z - j`t/$ ... . = 4 AUTHORIZED SIGNATURE: REVISED V26/03 DESCRIPTION OF WORK 0 OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS X 36.00 = 2 URINALS X 36.00 = 3 TUBS X $8.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ONSITE BUILT X 36.00 = 5 SINKS LAVSBASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT X $6.00 = 6 DISHWASHER X $6.00 = 7 CLOTHES WASHER X $6.00 = B GARBAGE DISPOSAL X $6.00 = 9 WATER SOFTENER X 36.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL X 36.00 = 11 FLOOR DRAINS AREA, CASE, COIL TRENCH, CONDENSATE X 36.00 ` 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS, DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6,00 = / 15 SEWAGE EJECTOR GRINDER SUMP PUMP X 36.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER X $6.00 = 17 CROSS CONNECTION DEVICE VACUUM BREAKER CHECK VALVE, AND R.P.B.P.D. FOR VATS, TANKS, BOILERS X $6.00 = 16 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAUSYS X 320.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: ArtA,SH 0 CHECK Cardo SUBTOTAL 44 D VISA D MASTERCARD PROCESSING FEE 335.00 EXPIRES: , TOTAL PERMIT FEE DUE: y/ AUTHORIZED SIGNATURE: REVISED V26/03