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2010, 12-21 Permit App: 10004096 Plumbing Fixtures
Permit Center " 011" 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: Spokane Valley,WA 99206 le ' (509)688-0036 FAX:(509)688-0037 PERMIT FEE: perm itcenterna,spokaneval ley.org Community Development Plumbing Permit Application ❑ Commercial Residential SITE ADDRESS: 4:39/.2q - Vl -C�* L% �-.4't Building Owner Name: e34 ,1, , Phone: c/5-7_ ,3> Fax: Address:, krl vet City:.5:464440e. V State: t. Zip:9910(k Contractor Name: �Li�L/�„ N.r f Phone: Fax: Address: '•yc� 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,Flo•4:undry,Utility,Janitor,Photo,X-ray,Food, SINKS.____ ep/Culinary Meat DISHWASHgL-. CLOTHES WASHER RBAGE 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 ❑CHECK 0 VISA 0 MC EXPIRES: Card# VIN: SIGNATURE: P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc