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2012, 06-18 Permit App: BLD-2012-0916 Drain Connect Spon"F 11703 E Sprague Ave,Suite B-3 r1 Spokane Valley,WA 99206 PERMIT NUMBER: ,�Z Qr� 4000 V .. ler (509)688-0036 FAX:(509)688-0037 PERMIT FEE: g ((zoo permitcentera,spokanevalley.org Community Development Plumbing Permit Application I I Commercial ,}Residential SITE ADDRESS: _ /5-0 /o� / -- X7:c_ 6- A re Building Owner Name: // �„(Gr dl Phone: 2'1`3 p ( O Fax: Address: / � O © ( e '�.. I Ave_ City: . /0- 0)6,in State: Z(/if Zip: Contractor Name: L r r Phone: Fax: �( ,1�'f� lcY (�x� �02�' /020® q2.2. — c—€7, / o Address: 7 E c e, E'Y /f-re City: 5;0 X/, ry State: � Zip: License No: City Busf ess Lic:X( Contact/Project Manager: Name: 2 ` r� /(2'Y- Phone: a ( 9 3J' f I #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 nn 1 WATER PIPING/DRAIN-IN WASTE 01g Installation,Alterations,Repair,Reversals C0//12eG!/P1L 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 9 VISA El 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