2009, 07-17 Permit App: 09002152 Plumbing ReversalPenna Center
rin (r tie 11703 E Sprague Ave, Suite B-3
P� 11Q`I17 Spokane Valley, WA 99206
'� Yalley' (509)688-0036 FAX: (509)688-0037
pennncenterespokanevalley.org
Community Development
Plumbing Permit Application
PERMIT NUMBER: ZjSt."
PERMIT FEE:
n Commercial P Kesidential
SITE ADDRESS: / 35-17 e /472.0y
- -
Name:
Phone: Fax:Address.
City 5pState: u_4 Zip-
/315-17
3 5 )—) F C!_ey
.,
'Contractor •
.. ,.
,e,Phone
Fax:Ne. 'B E i.at 1,/i`1'/
cAd
Address: 6%S I ill Le, YCity./reState: Zip. !i O`
License No: -t E ci ri1-10 City Business Lic:
Contact/Project 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
DISHWASHER •
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coll, 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 atmosphenc type vacuum breakers
MEDICAL GAS
INCEPTORS
['CASH 0 CHECK ❑ VISA 0 MC EXPIRES'
Card#
SIGNATURE:
VIN
CURRENT FEES AVAILABLE AT: http-//www spokanevalley.orq/ under the quick links for Forms, Master Fee Schedule.
http //wwwspokanevallcy.nig/uploads/Community_Development/Documenis/Fars/Building/PlumhingPermitApplicahon0440309.doc