2012, 08-23 Permit App: BLD-2012-1419 Plumbing FixturesSiolfease\''
...•i Malley
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenter!iespokaneval lev. org
&GC—zofz-/SSWl
PERMIT NUMBER:
PERMIT FEE: ,.11
Community Developmen:
Plumbing Permit Applicationp� % ❑ Commercial ,Residential
SITE ADDRESS: /I' o 5 F Q h / -Q /(o -7 " K/ ,4v e
Building Owner
Name'. A / Q i. ld
[.�" G /
yei Phone: v ,,, ? Q / Fx: q
/P. ®/�1,� LI P ik City: 0 2 s/4 State: 1474 Zip: f r2 f c
YYY
Address: �[ 0
Contractor
Name: A /V(" (/'
Gi i" ►'� � ( e e y'.�,t
�Xf :ifL:-K, Phone: ?uZ+c,''l e;ci Fax: e eZ "fel CJ
Ave./ J t� �/
tie /l City: Sl.c.,� %�t // t'y� State: K'4 Zip:/ ( (a
Address: 7 / L
License No: City Business Lic: r
Contact/Project Manager: "
Name: 1-+41 r r /14 / /A -r Phone: 02 / SP` ..7 ) -',_?3
# 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
i.f
WATER PIPING/DRAIN-IN WASTE
0 6��"a/'t Installation, Alterations, Repair, Reversals 5e wet.
/
WATER USING DEVICE
UIce 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
OCASH 0 CHECK 0 VISA 0 MC
Card#
SIGNATURE
EXPIRES:
VIN
\Community Development102 Administration\03 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc