2003, 05-08 Permit: BD-03-118 Plumbing ReversalSfiblane
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Plumbing Permit Application
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
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PROTECT
ADDRESS: 9t. 711i
OWNER:
MAILING ADDRESS:
PERMIT
USE:
/ !vr Y 9'c / IPHONE (Daytime Contact):
/ //.3 d 7 ie o ii 1ZN e -
(city Stale)
(street)
CONTRACTOR
MAILINGADDRFSS;
' (street) ,
DESCRIPTION
TOILETS
URINALS
TUBS
SHOWERS(PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATERSOFIENER
ELECT. HOT WATER TANK
FLOOR DRAMS
LICENSE t:
PHONE $:
(City/state)
PLUMBING FIXTURES
DETAILS
WATER CLOSET, BIDETS
BATH, SPALL, ON-SITR BUILT
LAVS/BAS W S, BAR FLOOR RTICHBN,
LA6NDRY UTR.PIY, JANITOR PHOTO,%
RAY, FOOD, PREP/CULINARY/MEAT
NOTE: IF GAS, SEE MECHANICAL
509-688-0036 - Phone
509-688-0037 - Fax
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fi/l'rs 9 512 /
(ZR')
(ZIP)
1 OF UNITS
FOUNTAINS, DRINKING
WATERPIFING/DRAIN_IN
VERTRUMBBVG
REVERSAL
AGE FJECrOR
WATER USING DEVICE
CROSS CONNECTION DEVICE
SPRINKLER SYSTEM
INTERCEPTORS
MEDICAL GAS per sued
20 MISC. PLUMBING FIXTURE
.TROD OP PAYMENT
CASH ❑ CHECK ❑
EXPIRES
IKCARD NUMBER
HORIZED SIGNATURE:
AREA, CASE, COIL, TRENCH, CONDENSATE
INSTALLATION, ALTERATION, REPAIR
REVERSALS .._
GRINDER SUMP PUMP
ICE AND/OR COFFEE MAKER HOSE BRE
STEAMER, PROOFER, CARBONATOR
SWAMP COOLER
VACUUM BREAKER CHECK VALVE, AND
RP.BP.D. POR VA , TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
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COST
Efi
$6
$6
$6
EQUALS
AMOUNT
$25
SUBTOTAL;
(00
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PLUS PROCESSING FEE
TOTAL PERMIT PEE DUE:
$35.00
9/-00
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