2012, 07-10 Permit App: BLD-2012-1063 Plumbing Fixtures��Valle3'�
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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Community Development
Plumbing Permit Application
SITE ADDRESS: � -/ .20C E
PERMIT NUMBER: 3 -
PERMIT FEE:
(7e. jj ❑ Commercial jResidentiat
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Building Owner/, 7o ring n Epee r sow
Name: Phone: Fax:
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Address: /'ILaOc Fej e�% e//Ow%�eCity: ,�dp/Ck1e l i3Or State: Vs/4 Zip: 91r,z(/
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Contractor
Name: �„ 4 k r A" t r,. ire - A -c A VG:' ( e Ky Phone: 9is� �,°` 4? 0a Fax: 47K,2 "
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Address: 7 / / C i' c. t,, Ave l City: J!"„c,k r State:
!/ / t" 1/s609 Zip: 9Y� ta
License No: City Business Lic:
Contact/Project Manager:
Name: 44 j„ jn u /14 //er Phone: 02 / g'" -335
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# 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
j�% 77 t
(C. Q // rp. h Installation, Alterations, Repair, Reversals 6,� veer
,
I�
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 Q CHECK 0 VISA 0 MC
Card#
SIGNATURE
EXPIRES:
VIN
r':\Community Development\02 Administration\03 Forms - Official VersionsWermit Center\Plumbing Permit Application 04-03-09 dg.doc