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2011, 09-26 Permit App: 11003020 Plumbing Fixturesan�r'1_Y� ,000Valley, Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 permitcenter4 spokanevalley.org Community Development Plumbing Permit Application � SITE ADDRESS: 3 �% / 5 Ark /roe PERMIT NUMBER: 1 I —aN)2,01 PERMIT FEE: ❑ Commercial 1tesidential Budding Owner Name: Phone: Fax: �hrss so���r�►� ���' a5o�— Address: 3 O t S / x '40.01 AW City: 5�e, x frC - State: t�� Zip: Contractor // Name: e— {. V:7 ,; f l C . � CrVit7Lt /", Phone: IaZ to ,/,200 Fax: lfa,2 , 5"O ( e, Address: 7 I ( c- X w7� A Ye City: S�v V /7e cj State: WA Zip: fr,z (A ,, License No: City Business Lic: Contact/Project Manager: Name: /eky, j„N //trek -Phone: „2 / 4D 3335 �`— / # 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 e FOUNTAIN, DRINKING Installation, Alterations, Repair, Reversals i/rri 12rciir- ( ith / ''''''' WATER PIPING/DRAIN-IN WASTE WATER USING DEVICE Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp cooter 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 0 CHECK 0 VISA 0 MC Card# SIGNATURE_ EXPIRES: VIN r:\Community Development \02 Administration\03 Fonns - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc