2012, 08-22 Permit App: BLD-2012-1409 PipingSPO7� rcnmr Uenrer
Ra` ne 11703 E Sprague Ave, Suite B-3
._�Y' q �p� Spokane Valley, WA 99206
rq'aHey (509)688-0036 FAX: (509)688-0037
ermitcenter s okanevalle .or
Community Development
Plumbing Permit Application
SITE ADDRESS: / 0 7 0(T �� O y – O X.G d–O S fF
r>a„
PERMIT NUMBER:&0-/Z•/ D
PERMIT FEE: 0,!r3-0
Commercial f�f Residential
Name: vO -e 6- i"rq--�S/14 t..��
Phone: Fax:
Address:
SPcoKane Val/ C State: /y fa Zip:
Contractor
Name: Y, '9 J l t' i -/r c�
Phone: 3 L 3 .� Fax:
Address:
,70
City:
City: State: Zip:
License No:
S'T rrO S J Ia 8 ci X11.. �
City Business Lie:
CnotacVProject Manager:
Name:{6.r 7lAd5 J�q.rr—
Phone:
ATMOSPHERIC TYPE VACUUM BREAKER
GAS
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
SIGNATURE:
EXPIRES:
VIN:
Other
CURRENT FEES AVAILABLE AT: http://�sookanevallev org/ under the quick links for Forms, Master Fee Schedule.
http://w .spokanevalley.orgluploads/Commmity_DevelopmentIDocuments/FormsIBuildin91PIumbingPermitApplication040309.doc