2004, 10-11 Permit App BLD-04-07884 Plumb ReversalProject Address:
Owner: C)
Mailing .ddresVd
s:
Contractor: (1.,p,,aiejl
Mailing Address:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuifdingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
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Phone LDaytin» Contact):
(1t14'
State Zip Code
Phone #:
License #:
City
City
State
DESCRIPTION OF WORK
# OF -
UNI ES
X
COST
= I
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
LAVSIBASINS, 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
=
e
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6A0
=
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
INSTALLATION,ALTERATION,
REPAIREVERSALS
> (
X
$6.00
=
/ L/`
L/�
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
r
=
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
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
, TOTAL PERMIT FEE DUE:
/
G-// 4?
BANKCARDNUMBER:
Zip Code
AUTHORIZED SIGNATURE: