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2005, 11-04 Permit App 05004196 Sewer ReversalSporkan"®e Valley Community Development Permit Center 11707 E Sprague Ave, Suite 106 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 wwrw.spokanevalley.org.com Plumbing Permit Application PERMIT NUMBER: 41 ` Lp PERMIT FEE: 4 ❑ Commercial ❑ Residential SITE ADDRESS: i I . - L` , /9.. a Building owner r- i f/ Name: 7,,b---lK,' /— , c c; i `r ��, v Phone: Fax: 1, ,N C`� Address: City State: Zip: _� Contractor l �i<Ci S / . ,�. Vic` . Name: Phone: Fax: �� Address: / �C`i ��% �. �� / City :� ,r �. , ; rz. • State: / %U�9 Zip: C-`�/ License No: 77/ c - * / G' 7/ ? City Business License No: Contact / Name: /�'."7,A -.7.-C .^r,; ram' l4i4/'/(J'E� Phone: �? % - 47 S - . .7" :Vs 7 ( 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 NSTALLATION, ALTERATION, REPAIR, REVERSALS / ! X $6.00 = ( C C ' 15 SEWAGE EJECTOR GRINDER, 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: / CASH ❑ CHECK El VISA 0 MASTERCARD Card# EXPIRES: SUBTOTAL 1'; EC PROCESSING FEE $35.00 TOTAL. PERMIT FEE DUE: , ,l// , e9 O AUTHORIZED SIGNATURE: REVISED S/26/05