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2011, 05-02 Permit App: 11001138 Plumbing FixturesSpokane �Miney. Permit Center 11703 E Sprague Ave, Suite 13-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 permitcenter@spokanevalley org Community Development Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: n Commercial Residential SITE ADDRESS: t2a-o(.0 47 %a✓G. 2 - Building Owner Name: Les K.»t .Phone: co 7 -SS 87 Fax: AddressState: Zi „Ip: n�• Dery 1Zd , City ,ra Lu ¢_ Uwlls-.P L04. p Contractor 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 1 7 URINALS TUBS SHOWERS (per trap) ( SINKS Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food, Prep/Culinary Meat 01. DISHWASHER CLOTHES WASHER GARBAGE DISPOSAL WATER SOFTNER FLOOR DRAIN Area, Case, Coil, Trench, Condensate I ROOF DRAIN/OVERFLOW DRAINS FOUNTAIN, DRINKING Installation, Alterations, Repair, Reversals WATER PIPING/DRAIN-IN WASTE 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 atmosphenc type vacuum breakers MEDICAL GAS INCEPTORS ❑CASH D CHECK D VISA DMC Card# SIGNATURE: EXPIRES: VIN: CURRENT FEES AVAILABLE AT: http://www.spokanevalley orq/ under the quick links for Forms, Master Fee Schedule. http://www.spokanevalley org/uploads/Community_ Dcvelopment/Documents/Forms/Budding/PlumbmgPermitApplicatlon040309.doe