2005, 03-29 Permit App 05001011 Plumb ReversalOwner:
Mailing Address:
Contractor:z-
Mailing Address:
:I Is
PLUMBING PERMIT APPLICATION
ne Phone: (509) 688-0036; FAX: (509) 688-0037
4,ValkY
For Inspections, CaII (509) 688-0054
ProjectAddr: s: 5 -.2y .i ''- Permit Use:
Phone (Daytime C ntact): '7c9 q -3�/
6 ° 0 I l'9 1f7
City State Zip Code
Z/j 14' Phone #:
State Zip Code
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY. JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA. CASE, COIL. TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING. REVERSAL
RATION, LTERATION, REPAIR,
ALTE
/REV
(
X
$6.00
=
—`
15
SEWAGE EJECTOR
��RRII SUMP PUMP
X
$6.00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS. TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH ❑ CHECK 0 VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
!/ [/( )
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: