2003, 06-09 Permit BD-03-286 Plumbing, ROWS` 6"kane
�,, i Valley
Plumbing Permit Application
11707 East Sprague .Menue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
1� 17 63'2Ce
PROJECT
ADDRESS: f /,. .77- 74/1—C.)USE:
/�
PERMIT
PHONE (Daytime Contact):
eaA 0 Oa_ 1 1 tO 6
OWNER: ,IQ
,<IA.�
MAILING AfD�DRESS:
L// 3 %_
' /L
.,_f
(street) (city/state) (ZIP)
CO�E_Ry map
1 r # 4 /
"
LICENSE #:
MAILING ADDRESS; : r
36i tC. S
. n-R
PHONE #: -
q 1-Syr 3
(street) (city/state) (ZIP) •
DESCRIPTION
TOILETS
URINALS
TUBS
SHOWERS (PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
ELECT. HOT WATER TANK
FLOOR DRAINS
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
m
INTERCEPTORS
MEDICAL GAS per outlet
MMEME
'HOD OF PAYMENT
ASH ❑ CHECK WSW
0
:CARD NUMBER:
[ORIZED SIGNATURE:
PLUMBING FIXTURES
DETAILS
WATER CLOSET BIDETS
BATH, STALL, ON -SITE BUILT
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
GRINDER, SUMP PUMP
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
NITROUS, OXYGEN
EXPIRES:
# OF UNITS X COST EQUALS AMOUNT
:7 '03
X $6
X $6
X $6
X $6
$6
Er
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL PERMIT FEE DUE:
..00
$35.00
41.0
City of PERMIT # PW — 3 2.,7
SPOKANE VALLEY
UTILITY RIGHT — OF — WAY APPLICATION
AND PERMIT
PUBLIC WORKS DEPARTMENT
APPLICATION
Location of property involved (or address) el/ 3 e-p.
a /-
Name of company 4 (1 _0yi f OY\
Address of company PO. f ('y' 0 k) f)._ phone 1-9 9 e J 9
Contractors name7�cLd C i f -Ae5-1 dPJx-°3 'wI`LT7'1
Contractors address P,b tr /-5� q 1 !! 50011q v4 phone 3 q 1 -99q,
Contractors registration Number Z Ae54-!1 b 77 gJL Expiration datey l/O JL L J
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person\----pitUti Hot, t7 .5 C�
Address of contact P 0 . f / ! -L% 514_,0 kj4-492Phone
Please explain in detail the description of the activity proposed.
6c 6 ,er %i e
qJ-�qI9
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercharge
Print name of holder Signature
PERMIT:
Special Conditions
Restoration:
Type of back fill to be used:
Permanent
gravel
Temporary
crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ?
A COPY OF THE CITY / UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE $ /0 INSPECTION FEE $
eCt3
Public ,'' orks Director
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R - 0 - W APP.