2011, 12-09 Permit App: 11003841 Plumbing FixturesPermit Center
'„Tam 11703 E Sprague Ave, Suite B-3
4.0f y Valle Spokane Valley, WA 99206
• (509)688-0036 FAX: (509)688-0037
Community Development permitcenter(aspokanevalley.org
• Plumbing Permit Application
SITE ADDRESS: D 7
.N
PERMIT NUMBER: if 1 _ 5
c°J
PERMIT FEE: 53--
El
3
❑ Commercial ❑ Residential
Building Owner
Name: V
Address: y10 7 N S ti f P -01v \�'
Contractor
Phone:
Fax:
City:
State: Zip:
Name: ps I ` r hri ( ` l vt 5"1 ; �J
Address: /4 S, -7 ' 1 k r- h €Tr
6 0 -2.67' -SS ?
License No:
Contact/Project Manager:
Phone: s Cl 7 ( _ I `} \ tFax:
State: W p— Zip: ci N - o �Y
City: SP d IcanL
City Business Lic:
Phone:
1V all..
# OF UNITS
TOILETS
WATER CLOSET, BIDETS
1
URINALS
TUBS
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR,
PHOTO,
1
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
ROOF DRAINS/OVERFLOW DRAINS
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
NOTE: IF GAS, SEE MECHANICAL PERMIT APPLICATION
INDUSTRIAL WASTE INTERCEPTOR
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,REVERSALS
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER,
PROOFER, CARBONATOR, SWAMP COOLER
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,AND BACKFLOW. FOR: VATS, TANKS,
BOILERS
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
INTERCEPTORS
GREASE TRAP, SAND TRAP,CHEMICAL HOLDING TANK
MISCELLANEOUS PLUMBING FIXTURE
FOUNTAINS, DRINKING
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA IZj MC EXPIRES:
Card# VIN:
SIGNATURE:
J �6
CURRENT FEES AVAILABLE AT: http://www.spokanevalley.org//uploads/Operations_and_Administration/Finance/MasterFeeSchedule.pdf
H:\DRAFT APPS\APPROVED\DRAFT plumbing APP.doc