2010, 10-21 Permit App: 10003472 Floor Drain, Sub-Slab4
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Spokane
#Malley.
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX (509)688-0037
permitccntcn67spokanevallev org
Community Development
Plumbing Permit Application
PERMIT NUMBER:
(U -34-1Q
PERMIT FEE:
4"' I• �V
❑ Commercial M\Residential
SITE ADDRESS: 3WI) 3 N . EI ` - c a (_Ac, I Ia Sa
Bdilding Owner,'. r "_-.. ;� �..w:-...>::: ._^ ;.:,.:-. Y....
Name: Phone' ' .=.. ,------, Fax
Ck�r s\-0Oct-ticKobe:
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Address x-�tno� N . C \ c 11 -ion city, po ns>_. State Zip: cnal:�
.Contractor .-
Phone
I_ 3,43��h Fax.
5O 1- 1aa-3i,Q
Name -to y \Z.//0_14T\\\Clk1\n�Qr�
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Address. \\30.13 G•O,ysYlmrIn •Ic f# R cl City: voov„...YI Q(.� State.
CCS^,�o Zip. IcIn�O(
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License No '0 c�2�� � 90a, -b5 City Bushiness LK' T 1 OQ / 031 B us
l Contact/Project Manager :-•. :::, "e- - - ,,,,
Name: Lki OA Phone. 5 r c -S ci aJ- G S'a p
1 1 1
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETSCj
URINALS
TUBS
SHOWERS (per trap)
�^
�\
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
'Y\
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATERSOFTNER
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
)4.
1
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
d
A
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
QCASH 0 CHECK 0 VISA 0 MC EXPIRES'
Card# VIN
SIGNAT
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P:\Community Development\02 Administration \03 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg doc