2011, 09-27 Permit App: 11003046 ROW, Sewer, Plumbing FixturesPermit Center
Spokane 11707 E Sprague Ave, Suite 106
`' leY Spokane Valley, WA 99206
rdl (509)688-0036 FAX: (509)688-0037
Community Development It ‘11% r• 1;;Inevzillo.orit.corn
Plumbing P,rmit Application
SITE ADDRESS:
2516 N Ella
Mail or Fax To: n r }
Norm's Excavating, Inc. 9 E 9 ti '°N
PO Box 574
Veradale, WA 99037
Fax: 892-0432
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PERMIT NUMBER:
PERMIT FEE:
n Commercial ® Residential
Building owner
DESCRIPTION OF WORK
Name: Chance
Phone: 926-2082
Fax:
Address: SAME
City: State:
Zip:
Contractor
WATER CLOSET. BIDETS
1
Name: None's Eircavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 5174
City : Veradale State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
X
Contact
=
Name: Sheila Gibbons
Phone: 928-0580
AUTHORIZE
S • d
SIGNATURE:
REVISED 8/26105
2Eb0E6B60S 2ur4eneox3 stuJoN e9E=80 IT LZ daS
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS 1
WATER CLOSET. BIDETS
1
X
$6.00
=
6.00
2
URINALS I
X
56.00
=
3
TUBS 1
X
56.00
=
4
SHOWERS PER TRAP)
BATH. STALL ON-SITE BUILT
1
X
$6.00
—
6.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, F000, PREP/CULINARY MEAT
1
X
$6.00
=
6.00
6
DISHWASHER
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
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIP NG/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
$6.00
=
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
$6.00
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
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20
MISCELLANEOUS PLUMBING
FIXTURE I
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X_
515.00
=
METHOD OF
0 CASH
Card# See
PAYMENT:
❑ CHECK ® VISA 0 MASTERCARD
Cover Sheet EXPIRES:
SUBTOTAL
24.00
PROCESSING FEE
TOTAL PERMIT FEE DUE:
24.00
AUTHORIZE
S • d
SIGNATURE:
REVISED 8/26105
2Eb0E6B60S 2ur4eneox3 stuJoN e9E=80 IT LZ daS