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2011, 08-01 Permit App: 11002279 DrainSpokane • cOValley. Permit Center 11703 E Sprague Ave, Suite 13-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 permiteenter(a)spokanevalley org Community Development _ Plumbing Permit Application• SITE ADDRESS: /y 7// Free&/ (fL PERMIT NUMBER: f (� 9Q-167 PERMIT FEE: Q y ❑ Commercial ySQI9( Cad Residential Building Owner Name Phone: Fax: Address: City: State: Zip: NamesContractor rc A Gq, h e Phone: 02 C/ —S V O p S Fax Address 7 9 S / „,-4,C- 5tic City: G eez„, .[ C re _S .'/ j l7 g L1/ State: ��✓, Zip: / �(O 6! CY V q License No: 6 U City Business Lie. Contact/Project Manager:ag� / Name) /r S -e ( , LI ✓'Gl�Gt i:o R Phone: 9 a 7-2 — � ger/2. / # 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 DISHWASHER CLOTHES WASHER 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 atmospheric type vacuum breakers MEDICAL GAS INCEPTORS ❑CASH ❑ CHECK 0 VISA ❑ MC EXPIRES: Card# - VIN: SIGNATURE: CURRENT FEES AVAILABLE AT: http.//www.spokanevalley orq/ under the quick links for Forms, Master Fee Schedule. http.//wwwspokaneval ley.org/uploads/Community_Development/Documents/Forms/But Iding/Plumb ingPenmtApplicatwn040309.doc i