2009, 06-17 Permit App: 09001782 Backflow DeviceStiokavie
cois0Ua11ey
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206 /�\�
(509)688-0036 FAX: (509)688-0037 19\ ' `
B -3--S61? \ `7
permncenter@spokanevalley ore, �✓
Community Development
Plumbing Permit Application
SII EADDRESS: ,P lila 11. Ce ,/ t
PERMIT NUMBER:
PERMIT FEE:
n Commercial Residential
Building Owner
Name. r Phone: Fax:
:S'e�* �fa� e Cic�9� 37n�3X�$ C5o4�4d�2-51g5
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/ / /)��yT R�/. City: C�n, �e 114 �YU State. i, /✓ Zip (,pd /2
Address. I/ 0?l_ / v ✓ W �! /,
Contractor J
Name: Phone: Fax:
Address City State: Zip.
License No: City Business Lic
Contact/Project Manager:
Name' Phone:
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS .
URINALS
TUBS
SHOWERS (per trap)
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
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, steamerproofer, 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
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Other than atmospheric type vacuum breakers
/
MEDICAL GAS
INCEPTORS
❑CASH CHECK ❑ VISA 0 MC
Card#
SIGNATURE -
EXPIRES:
VIN:
CURRENT FEES AVAILABLE AT: http-//www.spokanevalley orq/ under the quick links for Forms, Master Fee Schedule
http_//www.spokanevallcy org/uploads/Community_ Development/Documents/Farms/Building/PlumhingPerrnitApplication040309 doc