2011, 06-13 Permit App: 11001727 ROW, Plumbing FixturesSpokane
Valley
Community Development Department
Permit Center
11703 East Sprague Avenue, Suite B-3
Spokane Valley, WA 99206
Tel: (509) 688-0036
Fax: (509) 688-0037
oermitcenterCaispokaneva 1ley.orq
(Staff Use IOnjIV f
PERMIT NUMBER: 1 (()O 11 2.7
PERMIT FEE:
RIGHT OF WAY (ROW) PERMIT APPLICATION
❑ DRIVEWAY
CURB & GUTTER
PAVEMENT CUT (SEE BELOW) 0 SIDEWALK
OTHER
ROAD OBSTRUCTION 0 NO 0 YES ***TRAFFIC PLAN REQUIRED
PROJECT ADDRESS: 'J 36$ E U,4 -4-t( - 73ay, 14 & //
START DATE: ANTICIPATED COMPLETION DATE:
BUILDING OWNER NAME:
NAME: LJIv/Li g•►c V45&- / �YL/i�►a�w, �Osy0j 604
ADDRESS: 33R lit.114.1/ / -73/y j,4f/f/f
Sp, L,,,4
PHONE: FAX:
CITY:
STATE:
CELL:
ZIP: ViagiE 99z/7
CONTACT NAME: j E)cu4v4,Frtiy
PHONE: '2-51- e6 FAX:
CELL:
CONTRACTOR NAME: �{c.l,�c,gvA l�
MAILING ADDRESS: l goe, S 1 ihke- l
CITY:
PHONE: Zge
STATE: LA,i1
FAX:
ZIP: 47, of 6
CELL: D_ po s e
CONTRACTOR LICENSE No.: EXPIRES:
CITY BUSINESS LICENSE NO.:
TIER:
POLICY:
BOND/INSURANCE CERTIFICATE #:
(PER SVMC TITLE 10 ARTICLE 2)
SIGNATURE:
DATE:
****MUST BE COMPLETE IF PAVEMENT CUT****
TYPE OF WORK
CONDITION OF CUT
TYPE OF
REPAIR
EXISTING ROAD CONDITION
Gas
Sawcut
Asphalt
Depth of Asphalt:
Electric
Grind
(preapproved only)
Concrete
Depth of Gravel:
Water
CATV
Com
___-,--fewer
afher
Effective October 28, 2007 Page 1 of 2
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Right_of_Way_(ROW )_Permit_App_1-11-11.doc
Asphalt (width X length)
Concrete (width X length)
Locate Ticket #:
X
X
X
X
X
X
X
X
X
X
X
X
DISCLAIMER •
The permitted verifies, acknowledges and agrees by their signature that: 1) If this permit Is for construction or on a dwelling, the dwelling Is/will
be served by potable water. 2) Ownership of thls City of Spokane Valley permit Inure to the property owner. 3) The signatory Is the property
owner or has permission to represent the property owner In this transaction. 4) All construction Is to be done in full compliance with the City of
Spokane Valley Development code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) The City of
Spokane Valley permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional
Information may be required to be submitted and subsequently approved before this application can be processed.
Signature
Date:
PLEASE FAX TO CITY OF SPOKANE VALLEY (509) 688-0037 UPON COMPLETION
Effective October 28, 2007 Page 2 of 2
http://www.spokanevalley.org/filestorage/124/938/210/948/1496/Right_of Way_(ROW)_Permit_App_1-11-11.doc
k�7lillivlltp 11703 E Sprague Ave, Suite B-3
�rr• Spokane Valley, WA 99206
YAJ.�y� (509)688-0036 FAX (509)688-0037
4 peritcenter@spokanevafev.ern
Community Development
Plumbing Permit Application
SITE ADDRESS: /309 C IA4A,VI
Building Owner
Name:
Address:
Contractor
Name:
PERMIT NUMBER:
PERMIT FEE:
0 Commercial IJd'Residential
QAi.l EhF ✓rot, F 45 64
-13CA E tk4-A-4-
Phone: Far
City: S j% State:
Zip: 6}4/2,/2
"'t Ewt'A4414
Address: WOO i );nk6
License No:
Contact/Project Manager:
Name:
Phone: .-/-SOS3 Fax:
Cityc
Sate Zip: q?om
City Business Lie:
Phone:
PLUMBING FIXTURE ON A TRAP
A OF UNITS
TOILETS
URINALS
i
TUBS
SHOWERS (per trap)
SINKS
DISHWASHER
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Connery Meat
1
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
ROOF DRAIN/OVERFLOW DRAINS
Area, Case, Cog, Trench, Condensate
FOUNTAIN, DRINKING
WATER PIPING/DRAIN-IN WASTE
WATER USING DEVICE
PRIVATE SEWAGE DISPOSAL SYSTEM
Installation, Alterations, Repair, Reversals
Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp cooler
WATER HEATER
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
If Gas, See Mechanical
REPAIR OR ALTERATION
Including traps, vents except kitchen type grease interceptors functioning as fixture haps
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
MEDICAL GAS
Wates piping, drainage or vent piping
Other than atmospheric type vacuum breakers
INCEPTORS
OCASH ❑ CHECK 0 VISA 0 MC EXPIRES:
Card# VIN:
SIGNATURE:
CURRENT FEES AVAILABLE AT: htto:/Mnvw.spokanevallev.orq/ under the quick links for Forms, Master Fee Schedule.
hnp://www.spolcanevalley.orgiuplcrads/Community Dovelopment/Documents/Forms/Building/PlumbingPermitApplication040309.doc