2011, 04-14 Permit App: 11000931 Plumbing FixturesPermit Center
De 11703E Sprague Ave, Suite B-3
Spokane Valley, WA 99206 {�
Nadler (509)688-0036 FAX: (509)688-0037
permitcenter@spokanevalley.org
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Community Development
Plumbing Permit Application �
SITE ADDRESS: I a, -;ac E. -IJ
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PERMIT NUMBER:
PERMIT FEE:
n Commercial 3j esidential
Building Owner
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Name: V Ar ICS 1r(rT4L)c&r ? e 4)6 of t,\Q/^ Phone/ - 617L/ Fax:
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Address: () ) b E (44-k
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Contractor
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Name: m1c11 Te, 111' I'fA -e�P Phone:1S 060 c8 l 7 -eaW 9 Fax: (SO1j aa6 —a3 is
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Address:
, U t (1, OiC 1 5 9,-) City: V f o q P State: q Zip: ill 1 0'37
License No: City Business Lic: Oeptin P L q05 IRM
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Contact/Project Manager:
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Name: C. f. r 1 -LS S ( «- l -be 4/111- — Phone: S 0aj 9 s 1- 6 9 7 c,/
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# OF UNITS
PLUMBING FIXTURE ON A TRAP
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TOILETS
a
URINALS
Ai7 t
TUBS
1
SHOWERS (per trap)
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
DISHWASHER
,� /
/t//A
CLOTHES WASHER
I
GARBAGE DISPOSAL
1
WATER SOFTNER
N/A
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
1
ROOF DRAIN/OVERFLOW DRAINS
W/A
FOUNTAIN, DRINKING
NSA
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair Reversals
I
WATER USING DEVICE
Ice and/or Coffee maker, hose bib, steamer proofer, carbonator, swamp cooler
/ A
PRIVATE SEWAGE DISPOSAL SYSTEM
Ali / A
WATER HEATER
If Gas, See Mechanical
a
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps, vents except kitchen type grease Interceptors functioning as fixture traps
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REPAIR OR ALTERATION
Water piping, drainage or vent piping
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ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than atmospheric type vacuum breakers
/
/ rt' �14.
MEDICAL GAS
at' N/A
INCEPTORS
N / 4
['CASH 9 CHECK 9 VISA 9 MC
Card#
SIGNATURE:
EXPIRES:
VIN:
CURRENT FEES AVAILABLE AT: http://www.spokanevalley.orq/ under the quick links for Forms, Master Fee Schedule.
http://wwwspokanevalley.org/uploads/Community_Development/Documents/FormsBuilding/PlumbingPermitApplication040309.doc