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2012, 10-05 Permit App: BLD-2012-1752 Plumbing FixturesSpoka>e ,.Malley Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: 0 Commercial 0 Residential SITE ADDRESS: 8210 East Grace Ave Building Owner Thomas & Amanda Mott Name: Thomas & Amanda Mott Phone: (509)-671-2457 Fax: Address: 8210 East Grave Ave City: Spokane Valley State: WA Zip: 99212 Contractor Name: (509)-671-2457 Phone: (509)-671-2457 Fax: Address: City: State: Zip: License No: City Business Lic: Contact/Project Manager: Name: Thomas & Amanda Mott Phone: 509)-671-2457 # 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 PRETREATMENT INCEPTORS Including traps, vents except kitchen type grease interceptors functioning as fixture traps REPAIR OR ALTERATION Water piping, drainage or vent piping 2 ATMOSPHERIC TYPE VACUUM BREAKER BACK FLOW PROTECTIVE DEVICE Other than atmospheric type vacuum breakers MEDICAL GAS INCEPTORS OCASH ❑ CHECK ❑ VISA ❑ MC Card# SIGNATURE: EXPIRES: VIN: P:\Community Development\02 Administration\03 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc