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2004, 04-12 Permit App: BLD-04-04052 Plumbing Reversal t PLUMBING PERMIT APPLICATION SpcPf1'o` kaneli ,1, v City of Spokane Valley Community Development Department BuildingDivision lle y 11707 E. Sprague Avenue, Suite 106 .,VaJ 1 Spokane Valley, WA 99206 Phone: (509) 688-0036;Fax: (509) 688-0037 FOR INSPECTIONS, CALL(509)688-0054 Project Address: G 3// S /74r/•e_' Permit Use: Owner: Vi9N,:-e( /4,9-- 7 7 Phone (Daytime Contact): Mailing Address: -5:9-/-1 -e- // City State Zip Code Contractor: �A„�,.1�,q.,�P (' 37c7 _- License#4,„rcc-*igy,P7 Phone#: 9ar/-6','1 Mailing Address: /Fg/g L ,5;4,,a, ,P g✓'c...2/4J,49 S Z../ff 5;1.9e7 City State Zip Code #OF TOTAL DESCRIPTION OF WORK UNITS X COST = AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6.00 = 2 URINALS X $6.00 = 3 TUBS X $6.00 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 = 5 SINKS LAYS/BASINS,BAR,FLOOR, KITCHEN,LAUNDRY,UTILITY, X $6.00 = JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT 6 DISHWASHER X $6.00 = 7 CLOTHES WASHER X $6.00 = 8 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 X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 = /6©O VENT, PLUMBING,REVERSAL REPAIR,REVERSALS 1 (p 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB,STEAMER,PROOFER, X $6.00 = CARBONATOR,SWAMP COOLER 17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR: X $6.00 = VATS,TANKS,BOILERS 18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 = CHEMICAL HOLDING TANK 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X_ $6.00 = METHOD OF PAYMENT: SUBTOTAL (p,®a 0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 DATE: EXPIRES: TOTAL PERMIT FEE DUE: '//.©a BANKCARD NUMBER: AUTHORIZED SIGNATURE: