2010, 09-13 Permit App: 10002873 Plumbing Fixtures ''A„ Permit Center
S`iokane 11703 E Sprague Ave,Suite B-3 3 PERMIT NUMBER:
P Spokane Valley,WA 99206 ��„
Valley (509)688-0036 FAX:(509)688-0037 � PERMIT FEE:
permitcenter@spokanevalley.org
Community Development
Plumbing Permit Application n Commercial n Residential
SITE ADDRESS: t 53 I t e Ui(r 1 A-UE
Building Owner s)Q,V e y, Su uµ s -(1 2 ? -6 ‘9
9
Name: / Phone: f / Fax:
Address: / 5 2,l rT (JAL �� `� give,
City: Sl/Po ie -fu 2 V ALLQ ly State: (NA Zip: cl 7 o 5-2
Contractor
Name: ',4/z, Phone: e cs?/_ Q(0 Fax:
Address: City: F/'t= State: a/04Zip:
License No: City Business Lic:
Contact/Project Manager: �y
Name: � �( GAP/l /l1/7�erc Phone: 5 �Z3� l /p,
#OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS 0
TUBS
SHOWERS(per trap)
Lay/Basins,Bar,Floor,Kitchen,Laundry,Utility,Janitor,Photo,X-ray,Food,
SINKS Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER (O
FLOOR DRAIN Area,Case,Coil,Trench,Condensate CU
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 `V
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 0
MEDICAL GAS
INCEPTORS U/
CASH ❑CHECK 0 VISA 0 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