2004, 04-14 Permit App: BLD-04-04075 Plumbing Reversal PLUMBING PERMIT APPLICATION
S`p0ne Iry City of Spokane Valley Community Development Department
�JBuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
4i,
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
i \r\ FOR INSPECTIONS, CALL(509)688-0054
Project Address: '.c7DO I Permit Use:
Owner: D�L� Ci.,_,,s. d\..- Phone (Daytime Contact):l'22-3$
Mailing Address: Co`-)C> i, 6�`‘'‘ --'r _\,4e\\ --,\ ,�iTr• 2l2
City State Zip Code
Contractor: -\,,D-(, aV-,(- License#: 1 ORg ()t*hone#: -6 3
Mailing Address: f'Z DT c -)-W....10'VQ„ c-i-r p_ Lk. - 1?
City State Zip Co
#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
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
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
0 CASH g CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: LE:p A a D
D
47- /,,, F.--.