2011, 10-06 Permit App: 11003172 Plumbing Fixtures ♦ r
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Permit Center
a,*nr 11703 E Sprague Ave,Suite 13-3 PERMIT NUMBER: l I3 j 7 Z
Spokane Valley,WA 99206
4000 1leY (509)688-0036 FAX:(509)688-0037 PERMIT FEE: .—PcX
perm itccn ter(i e spoka n cva I I c y.org
Community Development
Plumbing Permit Application ElCommercial KResidential
SITE ADDRESS: _ 15—8 b a E 2.t 5+ A vc, L/5Z-52, P/0(
Building Owner
Name: Phone: Fax:
KFlrr � �1AQZ.tA DE'�/FtJ�'uSz-T 44 3 - 3 2a$'
Address: g Z i sk AYE City: J r vait
State: WA Zip: q9 O 3
Contractor I
Name: d IA.'M ESZ- Phone: Fax:
Address: City: State: Zip:
License No: City Business Lie:
Contact/Project Manager:
Name: 0 W 1J ER Phone:
#OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS(per trap)
Lav/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
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:
P:\Community Development\02 Administration\03 Forms-Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc