2012, 01-16 Permit App: 12000153 Tear Off, Reroof, Plumbing FixturesPermit Center (Staff Use Only)
P11703 East Sprague Avenue, Suite B-3
okane Spokane Valley, WA 99206 PERMIT NUMBER' IZ
jUalleya Tel: (509) 686-0036E: �"`I 7r
Fax: (509) 688-0037 PERMIT FEE
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REROOF CONSTRUCTION PERMIT APPLICATION
Q COMMERCIAL _ _ 8� RESIDENTIAL
ASSESSORS PARCEL NO.: LEGAL DESCRIPTION! 1
BUILDING OWNER NAME:
NAME:
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CITY:
SSTTjATE%:
ZIP-6R
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PHONE: �O� �7 / ��
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CONTACTNAME:
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CONTRACTOR NAME:
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CITY: "j STATE:
PHONE: Zoa- t77 -7z l FAX' SL{ Wl Q. CE
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CONTRACTOR LICENSE NO.:A6:EF-(' V:L!MP:PXPIRES Ce // IZOI CITY BUSINESS LICENSE N '
DESCRIBE THE SCOPE QF WORK IN DETA14 4ND INDICATE USE: 1. w. 1
Tear Off Q Overlay
TOTAL COST OF PROJECT: $ Z,i
DISCLAIMER
The permitted verifies, acknowledges and agrees by their signature that: I) If this permit is for construction or an a dwelling, one dwelling a/will
be served by potable water. 2) Ownership of this City of Spokane Valley permit Inure to the property owner. 3) The signatory Is the property
owner or has permission to represent the i y
property owner In this transaction. re 4) All construction Is to be done y full compliance ) h e City of
Spokane Valley Development per Referenced codes are available for federal,
s at the City of Spokane Valley Permit Center. ns The City of
Spokane Valley permit ui nota permit it approval for any violation approved
of federal, state p local laws, codes or ordinances. 6) Plans or additional
Information may be required [a be submitted and subsequeptly approved before this application can be processed.
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Community Developmcnt
Plumbine Permit
SITE ADDRESS:
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 992M
(509)688-0036 FAX: (509)688-0037
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PERMIT NUMBER:
PERMITFEE:
Commercial
Building Owoer
Name'
Phonc _ —7709Fax:
20 _
Address: F7City:
State:
Contractor
Nam¢:
Phone:
Fax:
Address:
City:
Slate:
Zip:
License No
City Business Lie.
ContactIrroject eager:
Name:
e
Phone:
9 O UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS mt
SINKS
Lav/Baams, Bar, Floor, KGohen, Laundry, Uthe. Janitor, Photo, X-ray, Food
Prep/Culinag Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case Coil, Tren It Condensate
ROOF DRAINIOVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER PIPINGIORAIN-IN WASTE
Installaton Alterations Repair, Reversals
�t H` pyLf
WATER USING DEVICE
Ice andhor Conroe maker, hose bib, steamer proofer, earbonator, Wramp moler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
If Gas, See Mechanical
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Includln tra s,ventsex kitnhenmawintemeptomf ndionin
as EAureta s
REPAIR OR ALTERATION
Water piping. dromage or vent paport
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other than atmoshenc type vacuum breakers
MEDICAL GAS
INCEPTORS
[]CASH [] CHECK [] VISA ❑ MC EXPIRES.
Caren VIN:
SIGNATURE:
CURRENT FEES AVAILABLE AT: http7jj%AV spokanevalleVone! under the quick links for Forms, Master Fee Schedule.
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