2011, 11-01 Permit App: 11003472 Drain ConnectSpokane
Permit Center
11703 E Sprague Ave, Suite 13-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
peritcenterfiispokancrallcv org
Community Dcvclopmen:
Plumbing Permit Application
PERMIT NUMBER: (I _ 3C17-2„
PERMIT FEE:
SITE ADDRESS: 7 t3 5 »o try r C /)
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❑ Commercial EFResidential
Building Owner
Name: Fax
ila y �r�y�e VI- Phone.5-36�-/ E�- 7�-
Address So 4 5 //-lo we 'e /,,t{P Gr City: s o Y� IfCY Slate (&A Zip:
Contractor
��,,// / Phone: 90y_6 • A� Fax: ?,,,,e,0 •.
Name' LA1.Nt7 /rli[ LY �XCoLYa"%rvtC� O�O/O
Address: 7 / / 7 C 7` tt fte-Y City: �! 0 (f_ /tv State: IIA Zip: 77:2_ 4,z
Ave�i /
License No: City Bu ness Liicr.~
Contact/Project Manager:
rt��t
Name' �LtNN y/4/7•• /ltr Phone: oZ / 52 — ,3/3 r
N 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
i
FOUNTAIN. DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations,/ons, Repair, Reversals — 7 QWtY
1 ..,
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 tixlure traps
REPAIR OR ALTERATION
Water piping, drainage or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than etmosphenc type vacuum breakers
MEDICAL GAS
INCEPTORS
QCASH 0 CHECK ❑ VISA 0 MC
Gordo
SIGNATURE
EXPIRES
VIN
.':\Community Development\02 Administmhon\03 Forms - Official Versions \Permit Center\Plumbing Permit Application 04-03-09 dg doc