2005, 08-19 Permit App 05003029 Sewer ReversalPfarie
PLUMBING PERMIT APPLICATION 3 3jCommunity Development Department
}} JJII Sui!ding Division
Phone: (509) 688-0036; FAX: (509) 688-003741,UL- 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: la/7
Owner Q.-: e-4,4:/vc, / cl er-
Mailing Address:
s
Permit Use:
LC)
Phone (Daytime Contact):
City
License #:
State Zip Code
Phone #:
Mailing Address:
City
State
Zip Code
DESCRIPTION OF WORK
# OF UNITS
X
COST .
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
=
2
URINALS
X
$6.03
=
3
TUBS
X
$5.0D
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSrrE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY. FOOD. PREP/CULINARY MEAT
X
$5.0D
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56.00
=
8
GARBAGE DISPOSAL
X
$6.oD
=
9
X
56.00
=
WATER SOFTENER
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.D0
=
11
FLOOR DRAINS
AREA. CASE, COL TRENCH, CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLAT1ON, ALTERATION, REPAIR,
REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTIONDEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS. TANKS, BOILERS
X
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.03
=
21
PRNATE SEWAGE DISPOSAUSYS
X
S20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE
SUBTOTAL
❑ VISA ❑ MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
'/, e)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: