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2012, 05-01 Permit App: BLD-2012-0526 Plumbing Fixtures11703 E Sprague Ave, Suite B-3 le, PERMIT NUMBER: Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 PERMIT FEE: �" �3 DD nermitcenter@spokanevalley ore Community Development Plumbing Permit Application ❑ Commercial XResidential SITE ADDRESS: Building Owner Name: Phone: a©— 3 1 1 3 Fax: Address: 30 ( 2{ Z City: S o State: Zip: �02 WA Contractor Name: /! �, Y CGcj/a int Phone: Fax: G Address: u I- Al'2 City: State: Zip: License No: City Business Lie: Contact/Project Manager: Name: ` y„(^ y Phone: # OF UNITS ON A TUBS SHOWERS Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food, SINKS Prep/Culinary Meat GARBAGE DISPOSAL WATER SOFTNER FLOOR DRAIN ROOF DRAIN/OVERFLOW DRAIN: FOUNTAIN, DRINKING WATER PIPING/DRAIN-IN WASTE WATER USING DEVICE PRIVATE SEWAGE DISPOSAL WATER HEATER REPAIR OR ALTERATION ATMOSPHERIC TYPE VACUUM BREAKER BACK FLOW PROTECTIVE DEVICE MEDICAL GAS ❑CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES: Card# VIN: SIGNATURE: and/or Coffee maker, hose bib steamer proofer, carbonator, swamp coolE If Gas, See Mechanical traps, vents except kitchen type grease interceptors functioning as fixture Water piping, drainage or vent cioina Ot CURRENT FEES AVAILABLE AT: http://www.spokanevalley.or_q/ under the quick links for Forms, Master Fee Schedule. http://www.spokanevalley. org/uploads/Community_Development/Documents/Forms/Building/PlumbingPermitApplication040309. doc