2005, 04-01 Permit App 05001041 Plumbing Reversal Cart(8 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
p0 ne Spokane Valley, WA 99206 509-688-0037-Fax
-Valley? For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: -;.; h t„,\) USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: j/ /_ Co h
'fir1.,c--ti O/.) LICENSE#: q S CO,,I ., • /a3!L 7j F
MAILING ADDRESS: PHONE tt: v
.) �.)C kane JOT^ , q&D 6
(street) (city/state) (LIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILET'S 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 LAVSBASINS,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 SOIF I bNER 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 X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING. REVERSALS X $6 - _
REVERSAL (
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
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 X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 -
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL:
ITHOD OF PAYMENT
. VISA' • •Insts9 ; PLUS PROCESSING FEE: $35.00
CASH ❑ CHECK ❑ wino ❑ b. .:='=:J
TOTAL PERMIT FEE DUE: G1(,m
TE: EXPIRES:
NKCARD NUMBER:
THORIZED SIGNATURE:
Cel24 hours b '� / \O"\\
Pharos 5134688 0036 Fax509_688-0037
re
�5 .
d "" DEPARTMENT OF PUBLIC WORKS
• Anticipated start date Permit#PW
ROW CONSTRUCTION PERMIT
Location of property 7 70 6 : ti. c/`a
(Address/Parcel#, If available)
Applicant Name -ba.t ' •-e
Address ,, Ec-ze .c1 Phone 4'3" 34
Contractors Name !7 4° S C;OAr St Y tL L.;n -
AdCkeeSI, i`7 £ Vailay way Phone 9.2.4
contractor'*Riggitires
PROJECT DESCRIPTION(Provide site sketch or plan as necessary for clarity)
Sewer Connection ! Driveway
nIL fl Gas irlesbion •
Other
Pavement Cut? Dimensions
Bondiinsuraace won must be on file sail the City.Bond it_..__ ..�..
SPECIAL.CONIX110114tk
•
Pennittee Signature Approved
I batty shies City&SpasmValleyb dame the fee fortis peansb nry audit card.
Card 1 Dago
Hems af'Hoidfer SAinetwo
Fees Paid$ Date hilt
(Application) (Inspection)
In addition to the permit application fee of$10.00 or$25.00,inspection on each permit will be
Wiled to the pennlitee at a sate of$60.00 per hour
these $25.00(1/2
and provisions.
Permitter)
signature on permit constitutes an agreement of
Work completed satisfactorily(Signed) Date
P �1 entered 1
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