2010, 02-05 Permit App: 10000311 Plumbing Fixtures• Spokane
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Permit Censer
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: l
PERMIT FEE: (i Q cr
Commercial 1 `'Residential
SITE ADDRESS: 9/d - 92 -o - S b y
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Building Owner __
Phone7r'�119 2�/% L/ (ci� Fax: U' Q7 a9 al Y
Name r/xi A -f i inn% /(9 L�
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Address: 1).No 4 1",..701",..70C f ore ) CG�y re-f�^ City:Ai ICY I''Ge�l LK Stale: L et__ Zip- Zip- 9 qp,y
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Contract,...: °- __ -. �'�",_ _., .r' . , - .. - _ - _
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Name: /-. O M �xj- `o'S p -r r rj 2 q1 2 ) Phone: / c9 O o' 2 Fax ¶o 9 299 y ((o I
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City. M 'met „co_ 1 t c State: � L''` Zip 41 5 O `Z 2
Address: a, o qv) y LA) M et C) a_t_e ��
License No: L.70 - Nr Al! 1 r 'C ----c Z City Business Lie
Contact/Project Manager. _ _ -___ - ._ _ _ _ _._ .._ .,. __ _ _.
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Name AA 0,r( r11 YLJ, Phone: 5'(9 `j �( QJ O o d 3 -
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
//�l
URINALS
/dam
p
TUBS
1
SHOWERS (per trap)
/
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utridy, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
DISHWASHER
1
CLOTHES WASHER
1
GARBAGE DISPOSAL
1
WATER SOFTNER
0
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
re—
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
-t<9---
WATER USING DEVICE
Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp cooler
`9—
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
If Gas, See Mechanical
1
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps, vents except kitchen type grease interceptors functioning as fixture traps
Q
REPAIR OR ALTERATION
Water piping, drainage or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than atmospheric type vacuum breakers
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MEDICAL GAS
' O
INCEPTORS
- -
❑CASH ❑ CHECK 0 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://wwwspokanevalley org/uploads/Community Development/Documents/Forms/Building/PlumbingPermitApplication040309 doe'