2011, 06-02 Permit App: 11001571 Tear Off, Plumbing Fixtures•
Spokane
4,0000Ualley•
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
perm itcenter(n spokanevallev.org
Community Development
Plumbing Permit Application
PERMIT NUMB$ % 1 (z„d
PERMIT FEE: 170423,
(1 Commercial
$I Residential
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SITE ADDRESS:
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Building Owner .-{-- I i
r r .) _ rr, f p 1 l. i Cr
Name:
C -o %. p y I , .. 4 \ iNQ /yam Phone: Fax:
Lr``!���1
Address: (���11 �y-2 vl�-n_
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/ (' ��.,) e /'� . f , I F City: sibk at; i l,t ,3_Au State: U)
Zip: /`?/,
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7�
/0 -i r.
Contractor . tj P`ki )(;\\) )\V C
Name: S 4(1>T P) Lt M /\ / , / /` Phone: Fax:
19 V li
City:�1,�j ('
Address: Pot Pe* I �� ty. J' State:
i yl l 1111 AI 1 to
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p: /Q
L
L -i -
License No: City Business Lic:
r
Contact/Project Manager:
Name: Phone:
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
'
URINALS
TUBS
i
SHOWERS (per trap)
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
,I
DISHWASHER
CLOTHES WASHER
j
GARBAGE DISPOSAL
I
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
I
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN. DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
WATER USING DEVICE
Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
If Gas, See Mechanical
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps, vents except kitchen type grease interceptors functioning as fixture traps
REPAIR OR ALTERATION
Water piping, drainage or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than atmospheric type vacuum breakers
MEDICAL GAS
INCEPTORS
❑CASH D CHECK D VISA DMC
Card#
SIGNATURE:
EXPIRES:
VIN:
P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc
Valley.
Community Development
Plumbing Permit Application
SITE ADDRESS: 10802 East Boone Ave., Spokane Valley, WA
Permit Center
11703 E Sprague Ave, Suite 13-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenter( spokanevallcy.orp
PERMIT NUMBER:
PERMIT FEE:
El Commercial In Residential
Building Owner -
Name: October Holding Company, LLC Phone: (509) 465-4959 Fax: (509) 777-1820
Address: P.O. Box 1810 City: Spokane State: WA Zip: 99201-1810
..
\ _ l ��
Contractor Ci'; \ r , , .V,XV\
Name: W\) 4.,` i CT (,�`�"D`'LY^`Phone: Fax:
Address: City: ; State: Zip:
License No: City Business Lie:
Contact/Project Manager: -
Name: April Key Phone: (509) 475-4959
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
.
2
URINALS
0
TUBS
2
SHOWERS (per trap)
' 0
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat .
3
DISHWASHER
0
CLOTHES WASHER
1
GARBAGE DISPOSAL
0
WATER SOFTNER
0
FLOOR DRAIN
Area, Case Coil, Trench, Condensate
O
ROOF DRAIN/OVERFLOW DRAINS
0
FOUNTAIN, DRINKING
0
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations Repair, Reversals
0
WATER USING DEVICE
Ice and/or Coffee maker hose bib, steamer proofer, carbonator, swamp cooler
0
PRIVATE SEWAGE DISPOSAL SYSTEM
0
WATER HEATER
If Gas, See Mechanical
? 00.1.)
• INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps, vents except kitchen type grease interceptors functioning as fixture traps
0
REPAIR OR ALTERATION
Water piping, drainage or vent piping
V 2
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
.
Other than atmospheric type vacuum breakers
0
MEDICAL GAS
0
INCEPTORS
0
❑CASH 0 CHECK 0 VISA 0 MC
Card#
SIGNATURE:
EXPIRES:
VIN:
CURRENT FEES AVAILABLE AT: http://wrwrw.spokanevalley.orq/ under the quick links for Forms, Master Fee Schedule.
hltp://wwwspokanevallcy, org/up loads/Community_Development/Documents/Forms/Build ing/Plumb ingPennitApplication040309. doe
pokane
jvailey
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
permitcenter@spokanevalley.orq
(Staff Use Only)
/1—/S?/
PERMIT NUMBER:
PERMIT FEE:
azo 3, 7.-
REROOF CONSTRUCTION PERMIT APPLICATION
COMMERCIAL In RESIDENTIAL
SITE ADDRESS: /0806 /o VO Vim_
ASSESSORS PARCEL NO.: 1 !)) /pR , 0v7LEGAL DESCRIPTION: la -E.
BUILDING OWNER NAME: C(1 \Qw\ (at 1Cvv\
NAME:
ADDRESS: sz;5,
CITY: C IYfI STATE:
PHONE:
CONTACT NAME:
FAX:
KOx\3,1\-
ZIP:
e
ZIP:
PHONE'p q 41 - pct
CONTRACTOR NAME:
•� �k1a cr2
FAX: S i M5-01 K/5 CELL: S oq t75 -4W?
MAILING ADDRESS:
CITY:
STATE:
ZIP:
PHONE:
FAX:
CELL:
CONTRACTOR LICENSE No.:
EXPIRES: CITY BUSINESS LICENSE NO.:
DE CRIBE THE SCOPE OF WORK I DETAILA,ND INDICATE SE:
Tear Off
TOTAL COST OF PROJECT: $ fQ O 0
0 Overlay
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: 1) if this permit is for construction or on a dwelling, the dwelling is/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit inure to the property owner. 3) The signatory is the property
owner or has permission to represent the property owner in this transaction. 4) All -construction is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5)• The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
information may be reired to be submitted and subsequently approved before this application can be processed.
Signature
Date: Gla) n[31-)1 J�
Updated 1-11-11 Page 1 of 1
http://www. spokaneva I ley.org/fi lestorage/ 124/938/210/948/ 1496/Reroof_Perm it_1-11-11. doc