2003, 12-17 Permit App: BLD-03-03295 Plumbing Reversal SCITY�xi�/1°# 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
j3okane Spokane Valley,WA 99206 509-688-0037-Fax
,,,,•*Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: LY 1 1 ti E ‘ 1 pot..q... USE:
OWNER: Lar r, i Sciu _pe� PHONE(Daytime Contact):
MAILING ADDRESS: t �C
CQrii/.71E 1 R-
(street) (city/state) S p es) ,jgtZIP) q9 a i a
CONTRACTOR: eGo t t l EXCa\lCn` LICENSE It: `1 ew ez E co 33,3 4.
MAILING ADDRE PHONE#:
P,0- ? t)( � y -� s (Ts-6 i) �a. car)
S po a„)z_ i•/ANA- 993,
(street) (city/state) (ZIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 =
2 URINALS X $6 =
3 TUBS X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 -
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 =
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 =
7 CLOTHES WASHER X $6 •-
8
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 AREA,CASE,COIL,TRENCH,CONDENSATE X $6 -
12 FOUNTAINS,DRINKING X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, I
WASTE,VENT,PLUMBING REVERSALS X $6 =
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 =
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X -
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC.PLUMBING FIXTURE X $6 =
SUBTOTAL:
METHOD OF PAYMENT
WM , "as ` PLUS PROCESSING FEE: $35.00
0 CASH ❑ CHECK ❑ .❑ '
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: