2012, 06-04 Permit App: BLD-2012-0814 DrainSpokane
Valky.
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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Community Development
Plumbing Permit Application
PERMIT NUMBER: Etd /i
PERMIT FEE: Li
❑ Commercial ,Residential
SITE ADDRESS: a / /-2 f/. C eh fir /1'/
Building Owner CA ix/ - JC v(u��a P
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Name: . Phone: !/rig_ 7 Fax:
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Address: 02t /� A/ C tVl c -v A- City: S e, /'& r Stale: W4 Zip. f92 /o
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Contractor /7
Name: 4. e,Yr 44,' (/e , Phone: Fax:
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Address' ,7 / / t 6 if kfle i- Ave City: stole (, 7/'l State: �� Zip:
9Y�z r
License No City Business Lic: T
Contact/Project Manager:— - _ - ; _ -
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Name: r r / //er Phone: (2 / f" 35
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# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS (per trap)
SINKS ..
Lav/Basins. Bar, Floor, Kitchen, Laundry, Utility. Janitor, Phalo, 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
�` j�/7 y)
) [.)((C' r Installation, Alterations, Repair, Reversals Baty 14a t h
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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
OCASH 0 CHECK 0 VISA 0 MC
Carats
SIGNATURE_
EXPIRES:
VIN
P:\Community Development\02 Administration \03 Forms - Official Versions\Permit Center \Plumbing Permit Application 04-03-09 dg.doc