2011, 08-08 Permit App: 11002364 Plumbing Reversalm„rltine�
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
pertnitcenteri spokanevallev org
Community Development
Plumbing Permit Application
PERMIT NUMBER: I I — Z4
4�- 1
❑ Commercial QResidential
PERMIT FEE:
SITE ADDRESS:
4-!C 5. fen gek
Building Owner
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Name /raga-- r ,1 T t /��/p Phone: 535-./-r71- Fax:
Address: 4
la 0! I i. City: s it r Stater Zip:
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Contractor
Name. r Phone' Fax:
an, /trT�-r �kcay ri.�
Par
Gy., / oa
Address: —7 if C G [lu- 1r f{✓R--. City:5 0 4 4L, State: fen. _ Zip Z (2(.2
License No: City B siness Lic
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
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case. Coil, Trench. Condensate
ROOF DRAIN/OVERFLOW DRAINS
e
FOUNTAIN. DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair Reversal 5 JtJt?
J
/
WATER USING DEVICE
Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp coder
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
OCASH ❑ CHECK O VISA ❑ MC
Card#
SIGNATURE
EXPIRES.
VIN
?:\Community Development\02 Administration\03 Forms - Official VersionsWermit Center\Plumbing Permit Application 04-03-09 dg.doc