2012, 07-10 Permit App: BLD-2012-1062 Plumbing FixturesStiolcane
....00.1F Val ley
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development 11112: ora com
Plumbing Permit Application
Mail or Fax To:
Norm's Excavating, Inc. 6S9 '0 NI
"
PO Box 574
Veradale, WA 99037
Fax: 892-0432
Commercial
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p,
AO 10\7- 10(01
PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS: I 8512 E Bow
Building owner
DESCRIPTION OF WORK
# OF UNITS
Name: Ulrich Phone:
926-4322 Fax:
TOTAL AMOUNT
Address: SAME
City:
State:
Zip:
Contractor
$6.00
-
6.00
Name: Norm's Excavating. Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradale State:
WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
Contact
X
55.00
Name: Sheila Gibbons
Phone: 928-0580
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
AUTHORIZED SIGNATURE:
-
REVISED V26/05
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DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
-
6.00
2
URINALS
X
86.00
=
3
TUBS
X
55.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
86.00
=
6.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
$6.00
6.00
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
GARBAGE DISPOSAL
X
86.00
9
WATER SOFTENER
X
$6.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
86.00
.,
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
$6.00
.
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
86,00
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND FLP.B.P.D. FOR VATS, TANKS, BOILERS
X
X
86.00
86.00
,
=
17
CROSS CONNECTION DEVICE
10
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
86.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
21
PRNATE SEWAGE DISPOSAL/SYS
X
$20.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card# See Cover Sheet
SUBTOTAL
24.00
CA VISA 0 MASTERCARD
PROCESSING FEE
37.00
EXPIRES:
TOTAL PERMIT FEE DUE:
61.00
AUTHORIZED SIGNATURE:
-
REVISED V26/05
911-rni;pAorlItn .=MACILA c.•c:an 2T nT Tnr