2010, 04-28 Permit App: 10001192 Piping Permit Center
7TFOF ne 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: , \.
Spokane Valley,WA 99206
0 Valley" (509)688-0036 FAX:(509)688-0037 PERMIT FEE: L?
permitcenter!cr spokanevallev.ore
Community Development
Plumbing Permit Application E Commercial RI Residential
SITE ADDRESS: AL1, ,� uA�/ Z/or—
Building Owner
Name:Gerald Hensley Phone: Fax:
Address:5011 Van Marter City:Spokane Valley State:WA Zip:
Contractor
Name:Self Phone: Fax:
Address: 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)
Lay/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
WATER PIPING/DRAIN-IN WASTE Installation,Alterations,Repair,Reversals 1
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:
CURRENT FEES AVAILABLE AT: http://www.spokanevalley.orq/under the quick links for Forms,Master Fee Schedule.
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