2006, 04-26 Permit App: 06001535 Sewer Reversal Permit Center /
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Sk �a`ne 11707 E Sprague Ave,Suite 106 •
Valley Spokane Valley,WA 99206 PERMIT NUMBER: ��3�
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(509)688-0036 FAX:(509)688-0037 _,01+.,
Community Development �ti�; .cp
w. okanevallev.ore PERMIT FEE44! ,
Plumbing Permit Application ❑ Commercial ❑ Residential
SITE ADDRESS:
Building Owns
Name: NJA,VVg13-TY\. 41-611.-• t Phone: Fax:
Address: 964� c ( City: State: Zip:
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Contractor l�nJ2c ..✓c / c. l PCLIM bl I ::
Name: Phonee722 /S-vi Fax:
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Address: /p E. S me . _/g'q/t ,�/w4 City: / 7 State: Zip:
License No: City Business Lic:
Contact . Q-
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•Name: .
Phone:
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL 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 =
LAVSBASINS,BAR,FLOOR,KITCHEN.
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
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 =
AREA CASE,COIL TRENCH,
11 FLOOR DRAINS CONDENSATE X $6.00 =
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13FOUNTAINS,DRINKING X $6.00 =
6 1
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,VENT,PLUMBING,REVERSAL REVERSALS / =X $6.004
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP
COOLER
VACUUM BREAKER,CHECK VALVE,
AND R.P.B.P.D.FOR: VATS,TANKS,
17 CROSS CONNECTION DEVICE BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑CASH 0 CHECK 0 VISA 0 MC EXPIRES: $35.00
Card# VIN: TOTAL PERMIT FEE DUE: 4// .----
AUTHORIZED
AUTHORIZED SIGNATURE:
REVISED 826/05