2011, 10-03 Permit App 11003097 Plumbing FixturesPermit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
perm itcenterV,spokanev al lev. org
Community Development
Plumbing Permit Application
PERMIT NUMBER: I \ _2Jc�ii
PERMIT FEE:
LtQ
n Commercial n Residential
frarjri ADDRESS:
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Building Owner
Name: Randy Simon Phone: 509-499-1153 Fax:
Address: 14521 E Broadway City: State: Zip:
Contractor
Name: 509-499-1153 Phone: 509-499-1153 Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact/Project Manager:
Name: Randy Simon Phone: 509-499-1153
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS (per trap)
SINKS
Lav/Basins, Bar, Floor, Kitchen, Laundry, Utility, Janitor, Photo, X-ray, Food,
Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area, Case, Coil, Trench, Condensate
ROOF DRAIN/OVERFLOW DRAINS
FOUNTAIN, DRINKING
kle r' 4010Eit,p1P1 AIN-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 ❑ CHECK ❑ VISA ❑ MC
Card#
SIGNATURE:
EXPIRES:
VIN: