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2004, 01-27 Permit App: BLD-04-03459 Plumbing Reversal Srrrt cx +/11 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone ane Spokane Valley,WA '9'206 509-688-0037-Fax 1_ .�•'�Valley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: 't/v 7�7,41 USE: OWNERYo ,,/ms, ���� A)i PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) , CONTRACTORG � j /lU. p LICENSE#: :�� � MAILING ADDRESS: PHONE#: (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 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, 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 $6 = HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 - 20 MISC.PLUMBING FIXTURE X $6 - SUBTOTAL: METHOD OF PAYMENT •,rifas PLUS PROCESSING FEE: $35.00 El CASH ElCI-IECK ❑ ElL.__... TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: LICENSE DETAIL INFORMATION Form Page 1 of 2 STATE OF WASHINGTON DEPARTMENT OF LABOR AND INDUSTRIES Specialty Compliance Services Division P. O. Box 44000 Olympia,WA 98504-4000 THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS: LICENSE DETAIL INFORMATION Current Filter: None Registration#or License GOODEP*983DM Name GOODELL PLUMBING Address 2610 WEST WOODSIDE Address City SPOKANE State WA Zip 99208 Phone Number 5093252368 Effective Date 3/14/2002 Expiration Date 3/14/2004 Registration Status ACTIVE Type CONSTRUCTION CONTRACTOR Entity INDIVIDUAL Specialty Code PLUMBING Other Specialties UNUSED UBI Number 602189140 'VIEW*VIEW CROSSREFERENCE FILE FOR THIS LICENSE* * * 'VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* ** 'VIEW*VIEW CONTRACTOR BOND/SAVINGS INFORMATION * *__* 'CHECK*CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* * * * * * VIEW CONTRACTOR INSURANCE INFORMATION **_* New inquiry by CITY , NAME , PRINCIPAL_OWNER NAME , LICENSEE , UBI NUMBER, check the L&I Contractor Industrial Insurance Premium Status or return to the L&I Construction Compliance Home Page https://wws2.wa.gov/lni/bbip/TF2Form.asp?License=GOODEP*983DM 1/27/2004