2013, 03-28 Permit App BLD-2013-0524 BackflowCar 28 13 04:11a
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Permit Center
11703 E Sprague Ave, Suite 3-3
Spokane Valley, WA 99206
(509)6S8-0056 FAX (509)68S-0037
oMmi:c_ ter Astok'dneveliev.nr'2
Community Development
Plumbing Permit Application
SITE ADDRESS: _ _
6l0(—(3-4z41
IPERMIT NUMBER:
PERMIT FEE: 3 %y
CO PVI
❑ Commercial 1SResidential
Building Owner . _
Name: b act n , .GeY
c2 n Phone: fa Z _v o `i Fax:
4
Zip:
',. Address City State:
,'7�pnr{ � ire, SSi on �J2
Contractor co r-e tler &r-2-en Sp,- ; n 1,/'{-S
Name: Phone: 41 See--! 23 L! Fax: t Cj S%18
Address: p o . B O .< iu e! ci ! Cry. .Sp et. at tit State: �� A- MI: % q Z. % - .
Linens: No: KorevG—Soi(o/BB City Business Lie: S p p ,E: a n .
ContactiProject Manager
Name: I.- 1 S Gt.. S A n de r Phone: g-0 q 4g q -! 2 3 Y
$ OF UNITS
PLUMBING FIXTURE ONA TRAP
TOASTS
URINALS'
TUBS
trap)
SHOWERS (per
SINKS
Lev/Basins, Bar. Floor, Ktchen. Laundry, utility, Janitor. Photo, X-ray, Food,
Prep/Culinary Meat
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTNER
FLOOR DRAIN
Area. Case. Cad, Trench. Condensate
ROOF DRAIN/OVERFLOW DRABS
FOUNTAIN. DRINKING
WATER PIPING/DRAIN-IN WASTE
Im1aIlGuon. Alterations. Repair. Reversals
WATER USING DEVICE
fee and/or Coffee mazer, hose bib. sMamer proo:er, carbonator. swamp voter
PRIVATE SEWAGE DISPOSAL SYSTEM
WATER fiEATER
U Gas, See Mechaniml
INDUSTRIAL WASTE PRETREATEMENT
INCEPTORS
Including traps. vents except kitchen type gren interceptors functioning as More traps
REPAIR OR ALTERATION
Water piping. dra eoe or vent piping
ATMOSPHERIC TYPE VACUUM BREAKER
BACK FLOW PROTECTIVE DEVICE
Other Man atmospheric type vacuum breakers
MEDICAL GAS
INCEPTORS
OCASH ❑.CHECK InVISA XMC EXPIRES:
CaTCIO
I.
REDACTED -
SIGNATURE:
t� 0` Scoot g-
REDACTED
This document originally contained confidential credit card
information which was redacted pursuant to RCW 19.255.010
and the original document destroyed pursuant to SOS DAN
GS2014-030.
CURRENT FEES AVAILABLE AT: htIo:fh xntspckanevaf'et.cm! under the quint( units for roans, waster ree acnepwe.
htrp97wrvvispokmevalley.org/uploads/Community DevelopmenUDouuments/Forms/BuildirdPltmbingPefmirApplication04U309.doe