2004, 07-20 Permit App: BLD-04-07110 Plumbing ReversalV%alky
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PLUMBING PERMIT APPLICATION
City o/ Spokane Valley Community Development Department
Building0oasion
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036, Fax: (509) 688-0037
c� t FOR INSPECTIONS, CALL (509) 688-0051
Project Address: 66 9� F E —
Owner: Q,L 4Ai tenni (" ,� - It _.
Permit Use:
Phone (Daytime Contact): ` of .
Mailing Addfess:'5Ami
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Contractor:�,o License#:/ �o /f/k%Phone#:5?,j
Mailing Address: /`?c/2 = 4, C6"1
City slate zip Cade
RANKCARD
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNRS
I %
I COST
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
K
5800
=
T
URINALS
X
3800
=
3
TUBS
X
Mw
=
4
SHOWERS PER TRAP
BATH, STALL, ONSITE BUILT
%
5800
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY. UTILITY,
JANITOR, PHOTO, X-RAY. FOOD.
PREPA:ULINARYAAEAT
X
5600
=
e
DISHWASHER
%
$6.W
=
7
CLOTHES WASHER
%
36.00
=
8
GARBAGE DISPOSAL
X
38.00
=
9
WATER SOFTENER
%
SB.W
=
10
ELECTRIC HOT WATER TANK
NOTE. IF CAS SEE MECHANICAL
X
38.00
=
it
FLOOR DRAINS
AREA. CASE. COIL. TRENCH,
CONDENSATE
X
58.00
=
12
ROOF DRAINSIOVERFLOW DRAINS
%
5600
=
13
FOUNTAINS DRINKING
%
3800
-
14
WATER PIPINGDRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION. ALTERATION,
REPAIR REVERSALS
/
%
38.00
(�
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
%
38.00
-
16
WATER USING DEVICE
ICEANIORCOFFEEMAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
x
3800
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE. AND R P BP D. FOR:
VATS, TANKS BOILERS
X
3800
=
18
INTERCEPTORS
GREASE TRAP, SANG TRAP,
CHEMICAL HOLDING TANK
X
5600
=
19
MEDICAL GAS rouge
NITROUS OXYGEN
X
3600
-
20
MISCELLANEOUS PLUMBING FI%TURE
%
38.00
=
METHOD OF PAYMENT:
*CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
DATE. EXPIRES:
SUBTOTAL
PROCESSING FEE
335.00
TOTAL PERMIT FEE DUE:
RANKCARD
AUTHORIZED SIGNATURE: