1995, 05-12 Permit App: 95003220 Plumbing Reversal PLUMBING PERMIT APPLICATION �'j,5 - 3
PROJECT ADDRESS: L /D4./7..Z 46-4'
OWNER: 44_,„-?7,7---- �4,,,z•�J PHONE:DAYTIME CONTACT
MAILING ADDRESS: te=e" .z-4..),...._ ! ??d z(
GP. (street) city/state)
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CONTRACTOR: (,QP._ J7'te4 LICENSE:
PHONE:
MAILING ADDRESS:
(street) (city/state) (zip)
PLUMBING FIXTURES #OF ,anal- COST
DESCRIPTION I DETAIL UNITS PLUM BY /UNIT aou as AMOUNT
B02 TOILETS WATER CLOSETS BIDETS x $6 = $
BO URINALS — x $6 = $
B04 TUBS BATH,JACUZZI,SPA,GARDEN x $6 = $
BO,,SHOWERS(per trap) BASE,STAR,ON—SITE BUILD x $6 = $
PO6 SINKS LAVs/BASINS,BAR,FLOOR,KITCHEN, x $6 = $
LAUNDRY,UTILITY,JANITOR,PHOTO,
X—RAY,FOOD(PREP/'CULINARY/MEA T)
-1307 DISHWASHER - x $6 = $
:B08 CLOTHES WASHER - x $6 = $
'B09 GARBAGE DISPOSAUGRINDER - x $6 = $
Bl0 WATER SOFTENER - x $6 = $
/3.11 ELECTRIC HOT WATER TANKS (NOTE: if gas water tank,see mechanical) X $6 = $
BIZ FLOOR DRAINS AREA,CASE,COLI.,TRENCH,CONDENSATE x $6 = $
813 ROOF DRAINS/OVERFLOW DRAINS(ea.) - x $6 = $
BI4 FOUNTAINS,DRINKING - x $6 = $
C WATER P1PTNO/DRAIFC e W TE-VENT/ LNSTALIATLON,ALTERATION,REPAIR, x $6 = $
LUMBING REVERSALS REVERSALS i
B16 SEWAGE EJECTORS GRINDER SUMP PUMP x $6 = $
B17 WATER USING DEVICES ICE AND/OR COFFEE MAKER, x $6 = $
HOSE BIB,STEAMER PROOFER,
CARBONATOR,SWAMP COOLERS
B18 CROSS-CONNECTION DEVICES VACUUM BREAKER,CHECK VALVE, x $6 = $
AND R.P.B.P.D.FOR:VATS,SUMPS,
TANKS,BOILERS,&SPRINKLER SYSTEMS
B19 INTERCEPTORS GREASE TRAP,SAND TRAP, x $6 = $
CHEMICAL HOLDING TANK
B20 MEDICAL GAS(per outlet/bottle station) NITROUS,OXYGEN x $6 = $
B21 MISCELLANEOUS FIXTURES x $6 = $
NOTE: MINIMUM PERMIT FEE IS$35.00 Subtotal
PLUS: PROCESSING FEE $25.00
SIGNATURE: TOTAL PERMIT FEE DUE $35---(1--).
PLEASE MAKE CHECKS PAYABLETO
Spokane County Division of Buildings SPOKANE COUNTY PERMIT CENTER
1026 W.Broadway Avenue*Spokane,WA 99260
Tel.No.(509)456-3675 •Fax No. (509)324-3198 •TDD No.(509)324-3166
Spokane County does not discriminate on the basis of disability in the admission to,or treatment or employment in,its programs or activities.
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