2013, 06-27 Permit App: BLD-2013-1235 Back Flow Device p.1
27 13 08:14a j It - Z3
Permit Center •
PERMIT I`E%MBER:
11703 E Spore Ave,Suite B-3 COPY
f j lix La Spokane Valley,WA 99206 PERMIT FEE:' 00
ill (509)688-0036 FA:(509)688-0037
- 1000
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Community Development
0 Commercial Residential
Plumbing Permit Application I
SITE ADDRESS: ,_ i /E__.. .6' .1 4-11 .
Building OwnerQ. a r"`���r — -
m.P. S Phone: Fax:
Name: .. • State: Zip:
2 6 ) 1-I-1 City:
Address: 6 � 1 2
Contractor ISO f-2 I%Z r & _ -1 ,--', '��`i{i S / Fax: ./`K,9 ,s/v T ma
Phone: q 3C-` 2 `.. / v
Name: ,��.S"'a State: 0,� 'lip: 9 l`/ 4 l
D. (_3 G ,G (0 4 / City: S P o/e a_-�-
Address: ! �� City Business Lie: s
p��Ctv7Lf
License No: F or - v Gr S (o/ G
Contact/Project Manager:
/e ur Phone: ..-o et •• q - l 2.3 Y
Name: L 5 pL 5 h"1/7(J *OF UNITS
PLUMBING FIXTURE ONATRAP
TOILETS
URINALS'
TUBS
SHOWERS •er era• LavBasins,Bar,Floor,Kitchen,Laundry,Utility,Janitor,Photo,Xray,Food,
Pre•Culi Meat
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATERSOFTN ER '
Area Case,Coil,Trench,Condensate
FLOOR DRAIN
ROOF DRAIN/OVERFLOW DRAINS
• FOUNTAIN,DRINKING
WATER PIPING/DRAIN-1N WASTE Installation,Alterations,Re.=Ir,Reversals
WATER USING DEVICE Ice and/or Coffee maker,hose bib steamer•rooter,carbonator,swam.cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS InGudi •Ira.s,vents exc-.1 kitchen •e•reaseInterne. orsfunetionin•as fixture tra.s
REPAIR OR ALTERATION Water.1•in.,drainaoe or vent•i•in•
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE Other than atmos•heric .e vacuum breakers
MEDICAL GAS
INCEPTORS
This document originally contained confidential credit card
REDACT h.1.) information which was redacted pursuant to RCW 19.255.010
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CASH 0 CHECK ❑VISA'Js�[MC EXPIRES: and the original document destroyed pursuant to SOS DAN
Cards _ _ RE,D4CTFD
SIGNATURE REDACTED GS2014-030.
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CURRENT FEES AVAILABLE AT:http:GhW W sl�Okanevalley.ora/under the quids links for Forms,Master Fee Schedule.
http:l:www.spokanevalley.orghuploads/Community_Development/Documems/Forms/Buildinelumbi gPermitApplication040309.doe