2009, 06-02 Permit App: 09001569 Back Flow Device _�NPermit Center
Tr'0kane' `'` 11703 E Sprague Ave,Suite /;69 PERMIT NUMBER:
'�'Y Spokane Valley,WA 992066
j Jey` (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
permitcenter@spokanevalley.org /
Community Development
Plumbing Permit Application ���,� / �/ /n Commercial/ � / n Residential
SITE ADDRESS: E � �� / L/L/ ��L✓� G �6u�C � lia �/ Gni 507.2(1,
Building Owner
Name: C .1.7-17) /� Phone: SDO w Fax:
Address: /63e) /n° / ��i�` City: ��1//�-��{ (/ tate: V,l' Zip: f 2O6
Contractor !�(/ �( '(/�/
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact/Project Manager:
Name: Phone:
#OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS(per trap)
Lav/Basins,Bar,Floor,Kitchen,Laundry,Utility,Janitor,Photo,X-ray,Food,
SINKS Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN Area,Case,Coil,Trench,Condensate
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 0 CHECK 0 VISA ❑MC EXPIRES:
Card# VIN:
SIGNATURE:
CURRENT FEES AVAILABLE AT:http://www.spokanevalley.org/under the quick links for Forms,Master Fee Schedule.
http://www.spokanevalley.org/uploads/Community_Development/Documents/Forms/Building/PlumbingPermitApplication040309.doc