2011, 09-07 Permit App: 11002763 ROW, Sewer, DrainSi
y
Community Development
Permit Centcr
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.ipokancvaller.org com
Plumbing Permit Application
Mail or Fax To:
Norm's Excavating, Inc, 0 0
PO Box 574
Veradale, WA 99037
Falc 892-0432
°N INV91:0l N '9 .ds U.ILL p/t RDq
PERMIT NUMBER:
PERMIT FEE:
L. Commercial (E) Residential
SITE ADDRESS: 8016 E Buckeye
Building owner
DESCRIPTION OF WORK
;7 OF UNITS
Name: Baxter
Phone: 927-9150
Fax:
Address: SAME
City:
State:
Zip:
. Contractor
56.00
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Addrcss: PO Box 574
City : Veradale State:
WA
Zip: 99037
License No: NORMSEI972BM
City Business !Accuse No:
Contact
X
56.00
=
Name: Sheila Gibbons
Phone: 928-0580
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
AUTHORIZED SIGNATURE:
r
E'd 2Et702GBROg
REVISED 8/26/05
2 utqeneoxa stuJom eT4:gn IT 9n deg
DESCRIPTION OF WORK
;7 OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
X
$6.00
=
3
TUBS
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
5
SINKS
LAVSIBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
56.00
6
DISHWASFIER
X
56.00
=
7
CLOTHES WASHER
X
$6.00
8
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH CONDENSATE
X
$6.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
13
FOUNTAINS, DRINKING
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT. PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
S6.00
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
-
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P,B.P.D. FOR: VATS, TANKS, BOILERS
X
56.00
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outle()
NITROUS, OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
21
PRIVATE SEWAGE DISPOSAIJSYS
1
X
$20.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515,00
-
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card# see cover sheet
la VISA 0 MASTERCARD
SUBTOTAL
6.00
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
6.00
AUTHORIZED SIGNATURE:
r
E'd 2Et702GBROg
REVISED 8/26/05
2 utqeneoxa stuJom eT4:gn IT 9n deg