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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: