2011, 04-11 Permit App 11000865 Wtr Pipingi ■ MP f. IV, LUI I 7;OLHw
i
Permit Center
11703 E Sprague Ave, Suite B-3
j Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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No. h28h N. 1
PERMIT NUMBER:
PERMIT FEE:
Community Development
Plumbing Permit Application
pplication ❑ Commercial Residential
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SITE ADDRESS: lS,, jF t Q
Buitdirtv ner
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Name:
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Address'
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City
Contractor "
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Name:
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Fax
Address: 13 cy�
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City:
License No.
State: Zip: Z� �O
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7 City Business Lic:
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PLUMBING FIXTURE ON A TRAP
0 OF UNITS
TOILETS
URINALS
TUBS
SHOWERS er Ira
SINKS
LaW6aslns, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Pre /Culinq Meat
DISHWASHER
CLOTHES WASHED
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area --se, Coil, Trench Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
WATER RAIN -IN WASTE
Inslellepgn Alterations, Repair, Reversals
WATER USING DEVICE
Ice end/Or COffee maker, hose bib, steamer roofer, carbonetor swam cooler
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER HEATER
INDUSTRIAL WASTE —PRE
TREATEMENT
if Gae, See Mechanical
INCEPTOR-3Includin
REPAIR OR ALTERATION
traps, Vents except kitchen type grease interceptors functioning
as (IMure Ira s
Water i in drain—or vent I In
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
MEDICAL, GAS
Other Ih-- BImOS heric t e vecuUM bfe9kars
IN S
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r1CASH ucry wow r,.
Cardrt REDACTED
ED
SIGNATURE: '4 z
.HLUAU I LU
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.2S5.010
and the original document destroyed
pursuant to SOS DAN GS2014-030.
P:1Community Development102 Adrninistration103 Forms - Official VersionsTermit CenterTlumbing Permit Application 04-03.09 dg.doc
Received Time Apr.10, 2011 9:47AM No,1781