2011, 07-26 Permit App: 11002217 Drain Connf
SpSkane
Walley•
Permit Center
11703 E Sprague Ave, Suite 13-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
perm itcenter(1)spokanevallev ore
Community Development
Plumbing Permit Application
SITE ADDRESS: &50.-3 EL/24,66r%%f
ToenNe
PERMIT NUMBER: 11— 2Zx
PERMIT FEE:
(43
El Commercial
aka 9%V2
yi Residential
Building Owner
Name Phone Fav'
NrJ�r.trr�r �- 7/d •o�i3
Addres (-9s-703' N. r-yliy edn% Cityuy State. Abil Zip.
raiz
Contractor
Name ,,CAmC Phone Fax:
Address City' State Zip
License No, City Business Lie
ContacUProject Manager:
Name Phone
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS (per trap)
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
-�
C
DISHWASHER
Si— '—'
CLOTHES WASHER
('--- C
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
)
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 atmosphere type vacuum breakers
MEDICAL GAS
INCEPTORS
DCASH 0 CHECK 0 VISA 0 MC
Card#
SIGNATURE
EXPIRES:
VIN:
P.\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg doc