2011, 07-21 Permit App 11002163 Bldg Drn ConnPermit Center
11703 E Sprague Ave, Suite B-3
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
permitcenterna spokanevallev,org
Community Development
Plumbing Permit Application
SITE ADDRESS: ✓ "� , ; 1, �C I
PERMIT NUMBER:
PERMIT FEE:
❑ Commercial n Residential
Building Owner
Name: 7,4- Phone: ; l l ca? g if 4 5 3Fax:
L� a
Address: 1 U -r < < c _ 'tZ �- N I City: be. el l i State: `F` Y -- Zip L l �.,jb
Contractor .ai k'
Name: Phone: Fax:
Address: City: State: Zip:
License No: City Business Lic:
Contact/Project Manager:
Name: Phone:
# OF UNITS
PLUMBING FIXTURE ON A TRAP
TOILETS
URINALS
TUBS
SHOWERS (per trap)
SINKS
LavlBasins, 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
WATER PIPING/DRAIN-IN WASTE
Installation, Alterations, Repair, Reversals
1
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 XVISA ID MC
Card#
SIGNATURE:
EXPIRES:
VIN:
P:\Community Development\02 Administration103 Forms - Official Versions\Permit Center\Plumbing Permit Application 04-03-09 dg.doc