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2011, 10-03 Permit App: 11003107 Drain Connect Permit Center (If U11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: / 1 1uaa� Spokane Valley,WA 99206 ,,,.Val ler (509)688-0036 FAX:(509)688-0037 PERMIT FEE: L4.3--- perm itcenter'aisrokaneva l Iev.org Community Development Plumbing Permit Application ❑ Commercial Residential SITE ADDRESS: 702 a / 5/v+'tlrp Ave- Building Owner / Name: ,Duclne FfDh- Phone: `7+C3 Fax: 3.2c -e 9 7 Address: City: State: Zip: Contractor Name: 40,1„..1,r �lF� � � fXc�� r�^� Phone: �o2 C—� o� Fax: 7242 _3-0 Address: <Ps City: State: Zip: License No: City Business Lic: Contact/Project Manager: Name: .4 a r r /4 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 asPIP 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 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