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