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2004, 04-22 Permit App: BLD-04-04169 Plumbing Reversal, Fixtures /ft.. • PLUMBING PERMIT APPLICATION flitf City of Spokane Valley Community Development Department p0, BuildingDivision Valley 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone: (509)688-0036;Fax: (509)688-0037 FOR INSPECTIONS, CALL(509) 688-0054 Project Address: ,c//- / Permit Use: Owner: },1,,,,., Se- .,41-t Phone (Daytime Contact): Mailing Address: . "/y t= /G)E . /,-, e--- lc f= L----( 97"c-e'Z City State Zip Code Contractor: /4-4i-i-i F_, 2,,ti. h G4 License#: JAL_ to Phone#: ...s-r --e,, ,,,---r Mailing Address: "3D2 / // /,/7 /7,1- „,,..,,,, ,,r-,-,•-:;--t "4- 9 ...., 7 State Zip Code #OF TOTAL DESCRIPTION OF WORK UNITS X COST = AMOUNT 1 TOILETS WATER CLOSET,BIDETS / X $6.00 = 2 URINALS 4 X $6.00 = 3 TUBS / X $6.00 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 = 5 SINKS LAYS/BASINS,BAR,FLOOR, KITCHEN,LAUNDRY,UTILITY, X $6.00 JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT 1 6 DISHWASHER X $6.00 = 7 CLOTHES WASHER X $6.00 = 8 GARBAGE DISPOSALX $6.00 = 9 WATER SOFTENERX $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 = CONDENSATE 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 = 14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 = VENT, PLUMBING,REVERSAL REPAIR,REVERSALS 1 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB,STEAMER,PROOFER, X $6.00 = CARBONATOR,SWAMP COOLER 17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR: X $6.00 = VATS,TANKS,BOILERS 18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 = CHEMICAL HOLDING TANK 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = METHOD OF PAYMENT: SUBTOTAL 0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 DATE: EXPIRES: TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: