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2005, 04-18 Permit App: 05001216 Plumbing Reversal PLUMBING PERMIT APPLICATION Community Development Department ,,,,, NOtaille\44 Building Division Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106 de/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206 C 675.12_/6 Project Address: 7074 ( 2_1t_.€ Permit Use: Owner: 69 q // F. 7d4-1(-- Phone (Daytime Contact): 7,9— -W/ Mailing Address: (, C/ // G ' /� sl 0M/X'e- 1 4 J ` 9.„1/,?---- . /,?---- City State Zip Code Contractor:7- ''--- Yt i �. • ' h.1.) Licen #: frit �L I/'{) Phone#: p Mailing Address: .' /-- 9/ 4dty D� .4 7/�/ C� State Zip Code DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6.00 = X 2 URINALS $6.00 = 3 TUBS X ' $6.00 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 = LAVS/BASINS,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 =- 11 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 = ROOF DRAINS/OVERFLOW X $6.00 = 12 DRAINS 13 FOUNTAINS,DRINKING X $6.00 = WATER PIPING/DRAIN-IN WASTE, NSTALLATION`.-_:TION,REPAIR, X $6.00 = 14 VENT,PLUMBING,REVERSAL 15 SEWAGE EJECTOR G' ',ER,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, 17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,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 = MISCELLANEOUS PLUMBING X $6.00 = 20 FIXTURE 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = INDUSTRIAL WASTE X $15.00 = 22 INTERCEPTOR SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE ❑ CASH 0 CHECK 0 VISA 0 MASTERCARD $35,410V/./ G�"- /�� DATE: EXPIRES: TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: