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2010, 05-05 Permit App: 10001266 Sewer ReversalPermit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 permitcenter(alspokanevalley ore liCommunity Development Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: n Commercial n Residential SITE ADDRESS: /7/ 5. /7%//.47// cL 6,,ekte/gezcs 4JAS/7 996/�a Building Owner - - - Name A2kpGd /itnw,it. Phone 5.,9-9.22-0/'1% Fax: Address: /// 5, ,J9/✓//cOLd City: �o�i-A04,eic'gj State -464S/1• Zip 9y,74 Contractor Name Phone. Fax: Address: City: State' Zip: License No: City Business Lic: Contact/Project 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 FOUNTAIN, DRINKING WATER PIPING/DRAIN-IN WASTE Installation, Alterations, Repair, Reversals / q 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 Card# SIGNATURE. ❑ CHECK ❑ VISA ❑ MC EXPIRES: VIN CURRENT FEES AVAILABLE AT: http.f/www.spokanevalley orq/ under the quick links for Forms, Master Fee Schedule http //www.spokanevallcy org/uploads/Community_Development/Documents/Forms/Bwlding/PlumbmgPennitApplication040309.doc