2004, 06-04 Permit App BLD-04-04494 Plumb ReversalSpola' e�'°
a "Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildfngOivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: 4j f/I D zr. z r tit.4 . Permit Use:
Owner: - .067 ,✓l ra-v
Mailing Address /2 wf ir1. id-ciee,
Contractor. if/%i
Mailing Address:
License #:
Phone (Daytime Contact):
City
3JA • ffhW
State Zip Code
Phone #:. 2'9- 79/ :13-r.?
City
State
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
LAVSIBASINS, BAR, FLOOR
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
X
$6.00
=
PREP/CULINARY/MEAT
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6A0
=
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
INSTALLATION, ALTERATION,
REPAIR REVERSALS
l
4
X
$6.00
=
0 0
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICEAN/OR COFFEE MAKER,
HOSE BB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND RP.BP.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
1 ,
�u `0
PROCESSING FEE
$$35.00
TOTAL. PERMIT FEE DUE:
/ /l
_ i I • O L�
BANKCARD NUMBER:
Zip Code
AUTHORIZED SIGNATURE: