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2003, 12-01 Permit App: BLD-03-03168 Plumbing Reversal
SDolcrr4<x> r® �riart 11707 East Spragug Aversle, Suite 106 509-688-0036-Phone c ne Spokane Valley,WA 99206 509-688-0037-Fax Walley For Inspections, call' 509-688-0054 Plumbing Permit Application ,-) 0, ,9 ' ! L� . PROJECT PERMIT ADDRESS: l l "1 1 ( - r q rd USE: OWNER: F� j LAJ PHONE(Daytime Contact): MAILING ADD ESS: l I a. t ;3. C_ 6-( ,3 r d -)0 LA.) q'9 0_ CC (street) (city/state) (ZIP) COI}- tR:�to l CLIC)VI i(L it (1 %A LICENSE 1/: MAILING ADDRESS: l 3 PHONE#: — 3 C1 /D1i rx- S q,D 15 1 3 40 ryi<6.. yuz 10 ci__ q q 6 47 (street) (city/state) (ZIP) - PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6 = 2 URINALS X $6 - 3 TUBS X $6 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 = RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER X $6 7 CLOTHES WASHER X $6 8 GARBAGE DISPOSAL X - $6 9 WATER SOFTENER X $6 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 - 12 FOUNTAINS,DRINKING 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, X $6 .. WASTE,VENT,PLUMBING. REVERSALS X $6 REVERSAL / Gf • `_ \ 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X L/'I/vJ 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, STEAMER,PROOFER,CARBONATOR, X $6 SWAMP COOLER = 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 - 17 SPRINKLER SYSTEM 18 INTERCEPTORS X $25 - GREASE TRAP,SAND TRAP,CHEMICAL HOLDING TANK X $6 19 MEDICAL GAS per outlet NITROUS,OXYGEN 20 MISC.PLUMBING FIXTURE X 6 X $6$6 = IOD OF PAYMENT SUBTOTAL: SH ❑ CHECK ❑ ❑ ! J='�_'__ PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: c// 73 , EXPIRES: (�C! :ARD NUMBER: )RIZED SIGNATURE: