2011, 10-04 Permit Application: 11003120 Plumbing FixturesPermit Center
Spokane "`_ 11707 E Sprague
Spokane Valley,
(509)688 -0036 F
Community Development
Plumbing Permit Application
Valley
SITE ADDRESS: 14405 E Alki
ve, Suite l06
A 99206
X:(509)688 -0037
Mail or Fax To: '79L17 0 alUl aAla�2
Norm's Excavating, Inc. N 108S:6 1.1H 0 ,. P ,
PO Box 574
Veradale, WA 99037
Fax: 892 -0432
11
PERMIT NUMBER:' ( -5k20
PERMIT FEE:
CQl
Commercial ® Residential
1
DESCRIPTION OF WORK
TOILETS
2
3
4
5
URINALS
TUBS
it OF UNITS
X
COST
TOTAL AMOUNT
WATER CLOSET, BIDETS
1
X
56.00
56.00
6.00
X
56.00
SHOWERS (PER TRAP)
SINKS
6
7
8
9
10
11
12
13
14
15
16
DISHWASHER
BATH, STA L, ON -SITE BUILT
LAVSIBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
1
X
56.00
6.00
1
X
$6.00
6.00
X
$6.00
CLOTHES WASHER
X
$6.00
GARBAGE DISPOSAL
WATER SOFTENER
X
56.00
X
$6.00
ELECTRIC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
56.00
ROOF DRAINS/OVERFLOW
DRAINS
FOUNTAINS. DRINKING
AREA, CASE, COII, TRENCH, CONDENSATE
X
56.00
X
56.00
x
$6.00
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
56.00
6.00
GRINDER, SUMP PUMP
X
56.00
WATER USING DEVICE
17
18
19
20
21
CROSS CONNECTION DEVICE
INTERCEPTORS
ICEAN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
VACUUM BREAKER. CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING
FIXTURE
x
56.00
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
22 INTERCEPTOR
X
$20.00
X
$15.00
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
Card# See Cover Sheet
AUTHORIZED SIGNATURE:
El VISA
❑ MASTERCARD
EXPIRES:
SUBTOTAL
24.00
PROCESSING FEE
37.00
TOTAL PERMIT FEE DUE:
61.00
REVISED 8126)05
I 1
Building owner
Name: Potts
Phone: 924 -2784
Fax:
Address: SAME
I
City: State:
Zip:
Contractor
Name: Norm's Excavating, Inc
I I
Phone: 5091928 -0580
Fax: 509/892 -0432
Address: PO Box 574
1
City : Veradale State: WA
Zip: 99037
License No:NORMSEI972BM
I
City Business License No:
Contact
Name: Sheila Gibbons
Phone: 928 -0580
1
DESCRIPTION OF WORK
TOILETS
2
3
4
5
URINALS
TUBS
it OF UNITS
X
COST
TOTAL AMOUNT
WATER CLOSET, BIDETS
1
X
56.00
56.00
6.00
X
56.00
SHOWERS (PER TRAP)
SINKS
6
7
8
9
10
11
12
13
14
15
16
DISHWASHER
BATH, STA L, ON -SITE BUILT
LAVSIBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
1
X
56.00
6.00
1
X
$6.00
6.00
X
$6.00
CLOTHES WASHER
X
$6.00
GARBAGE DISPOSAL
WATER SOFTENER
X
56.00
X
$6.00
ELECTRIC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS, SEE MECHANICAL
X
56.00
ROOF DRAINS/OVERFLOW
DRAINS
FOUNTAINS. DRINKING
AREA, CASE, COII, TRENCH, CONDENSATE
X
56.00
X
56.00
x
$6.00
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
56.00
6.00
GRINDER, SUMP PUMP
X
56.00
WATER USING DEVICE
17
18
19
20
21
CROSS CONNECTION DEVICE
INTERCEPTORS
ICEAN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
VACUUM BREAKER. CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
MEDICAL GAS (per outlet)
NITROUS. OXYGEN
X
$6.00
MISCELLANEOUS PLUMBING
FIXTURE
x
56.00
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
22 INTERCEPTOR
X
$20.00
X
$15.00
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
Card# See Cover Sheet
AUTHORIZED SIGNATURE:
El VISA
❑ MASTERCARD
EXPIRES:
SUBTOTAL
24.00
PROCESSING FEE
37.00
TOTAL PERMIT FEE DUE:
61.00
REVISED 8126)05