2011, 04-27 Permit App: 11001073 Plumbing Fixtures`i bkane
40,00Valley.
MP
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenter(uspokanevalley. org
Community Development
Plumbing Permit Application , 1
SITE ADDRESS: ( �1 / C
PERMIT NUMBER:
PERMIT FEE:
n Commercial Residential
Building Owner
Name: f.{ ti cik J)(-0 A -fl Phone: Fax:
Address 1 IJii—,Zip:
iv, r %f'F- � City:
Kt vA Q State: 1,v 1
i ,(:� _go
Contractor
Name: (-J(-J( , j__)/ V ) b t J i ! it)' C . Phone: ‘7cZ. �---6 Fax:
/[�� y� ,' /�'
Address: / 1 c ) City: AORC in State: tiL W Zip: ,996,.. U
License No: j : City Business Lic:
/- /,
L./940
ContactlProject 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
r
ry
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
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 ❑ VISA ❑ MC EXPIRES:
Card# VIN:
SIGNATURE:
CURRENT FEES AVAILABLE AT: http://www.spokanevalley.orq/ under the quick links for Forms, Master Fee Schedule.
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/PlumbingPermitApplication040309. doc