2013, 03-07 Permit App: BLD-2013-0370 Plumbing FixturesMar. 7. 2013 11:09AM
Permit Center
S�Q a 11703 E Sprague Avo, Suite B-3
ate.Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
pennit enterrnlcnokanevalIev.ore
Community Development
Plumbing Permit Application
SITE ADDRESS: 1 2- _ (1 ET Vbl /4-X V - tL
COP
No. 9409 P. 2
11-19-2M • 031,0
ERMIT NUMBER!
PERMIT FEE:
❑ Commercial
Residential
Building Owner
Name: 'Y IjY( N - Ru ( Phone: Fax:
1, ISO
Address:
IAA -e_ City: Star/WE UL(, Stale: imil zip: yet 2 Z.3
Contractor
Name: i\krnee elo 5 S te-`--r- friAc L Phone. Fax:
Address: 1ow 3 1-12 -f City: , yK C L 7 State: IA!4- Zip: q 9 2!<,
License No: re 9._ Set Co .5 16 City Business Lie: tel, Q 4 73OS' S0 C
Contac&Project Manager: 'c: & .
vim/-
Name: Phone:
Mgr
, rCS ,, �/
&K( wKtltP oft PIA, FOTZ fbGk i�1✓,`,enf
#OF UNITS
PLUMBING FIXTURE ON A TRAP
I e/T'I 'FI
TOILETS
1
URINALS
TUBS
SHOWERS (per trap)
i
SINKS
LavBasine, Bar, Floor, Kitchen. Laundry, Utility, Janitor, Photo. X-ray, Food.
Prep/Culinary Meat
7
DISHWASHER
CLOTHES WASHER .• •
t
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coll, Trench. Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER PIPING/DRAIN-IN WASTE
Ioslaltalion Alterations, Repair, Reversals
WATER USING DEVICE
los and/or Coffee maker, hose bib steamer proofer, carbonatOL swamp cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
II Gas See Mechanical
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps, vents except kitchen type crease interceptors functioning es fixture (rape
REPAIR OR ALTERATION
Water piping, drainage or vent plping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than atmospheric lyoe vacuum breakers
MEDICAL GAS
INCEPTORS
UCASH ❑ CHECK [VISA ❑ MC
Cards REDACTED
SIGNATURE:
Cts Wit -c.-.
EXPIRES: REDAC
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN G52014-030.
P:\Community DevelopmenA02 Administration \03 Fonns - Official VersionsWermit CenterlPiumbing Permit Application 04-03.09 dg.doc