2007, 07-12 Permit App 07002676 Sewer ReversalSpokane
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
40,00Valley. www.svokanevalley.org
Community Development
Plumbing Permit Application
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SITE ADDRESS: 008 " V (r/LI
PERMIT NUMBER: C -7 -
PERMIT FEE: L�
n Commercial `°Residential
Building Owner
Name: ek.11
Phone:
Fax:
Address: ' 3 C O cl c yyN,i{_ l (
City:
State:
Zip:
Contractor
Name: ---b ,s.no, p i t.,r✓b„
Phone: 5 zZ- % S . J i
Fax:
Address: i 6- ill G, \c 4-' 16.1 I
City:
State:
Zip:
License No:
City Business Lic:
Contact
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Name: 4-,rJ{ L,v,-c.Lvt•i✓C
Phone: cf 2 t /_ S1.1✓S".5—
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DESCRIPTION OF WORK
TOILETS
2 URINALS
TUBS
SHOWERS PER TRAP
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
17 CROSS CONNECTION DEVICE
18 INTERCEPTORS
19 MEDICAL GAS (per outlet)
20 MISCELLANEOUS PLUMBING FIXTURE
21 PRIVATE SEWAGE DISPOSAUSYS
22 INDUSTRIAL WASTE INTERCEPTOR
METHOD OF PAYMENT:
FASH III CHECK El VISA El MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
# OF UNITS
WATER CLOSET, BIDETS
BATH, STALL, ON -SITE BUILT
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH,
CONDENSATE
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
GRINDER SUMP PUMP
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS,
BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS OXYGEN
EXPIRES:
VIN:
COST
X $6.00
X $6.00
$6.00
$6.00
I $6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
$6.00
X $6.00
X $6.00
X $20.00
X $15.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
TOTAL AMOUNT
$35.00