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2011, 11-01 Permit App: 11003471 Plumbing FixturesPermit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 permitcenter rOstiokanevallev.ors Community Development Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: y3� SITE ADDRESS: 3 / �.2 ) L— /'/ , ❑ Commercial ,Residential Building Owner Phone: 7397_ 0,r 7? Fax: Name: r r. �� , n`9 /,%/r 13'/ Address: �) /r� i , 7� �4� City: S�0 V` A 7, State: 1/.1/fe- Zip:7„ 2 /2., Contractor 1 Name: �� �n�„/?7,1�Y CG, )/Lc / I yr it Phone: q�‘./ o Fax:.7� 2 _ .5-, / c' (;� Address: 7 / ('j E q .¢,C -e j Ave / City: ! /t [ /7 KL//C,7 State: k4e Zip: GT��/� / / License No: City Bu iness Lic: Contact/Project Manager: / — Name: xa 0,, f //C r Phone: / C,' 3yl3 # 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, Repair, Reversals - f¢ Vie r / 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 0 MC Card# SIGNATURE EXPIRES: VIN r:\Community Development\02 Administration103 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc