2011, 06-01 Permit App: 11001548 Drain ConnectSpokane
co:01/211eyr
:% • Y
Permit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenterfaispokanevalley.org
Community Development
Plumbing Permit Application
n� /
SITE ADDRESS:��JJli v'//(v h�i�y/X2��P'e
1 /-15/8
q3
PERMIT NUMBER:
PERMIT FEE:
n Commercial
Residential
Building Owner j/ r 4 h, S C i U//
/7
Name:
Phone- Fax:
Address:
City: State:
Zip
Contractor
Name: /�
/�S (d/sogs
Phone Fax:
�'dG-cjG�
Address 7/ /, / 12//
City: State
Zip
License No: / .S e„,0, /7?
, City Business Lic:
if
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
-.------s...
FOUNTAIN, DRINKING
\
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
\\\VVV
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 atmosphenc type vacuum breakers
MEDICAL GAS
INCEPTORS
DCASH 0 CHECK ❑ VISA 0 MC
Card#
SIGNATURE:
EXPIRES:
VIN:
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