2012, 06-26 Permit App: BLD-2012-0976 Water PipingPermit Center
pane 11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development ;%•,;" ,pgkancsall_\ cve.cum
Plumbing Permit Application
....IF Valley
Mail Ex To:PO oo�7g 'oN Wb9l Ol ZIOZ 9Z 'unp anvil pani 13;'
Norm's Excavating, Inc.
Box 574 ,��
Veradale, WA 99037 0—
Fax: 892-0432
PERMIT NUMBER:
PERMIT FEE:
❑ Commercial ® Residential
SITE ADDRESS: _4202 N Burns i-1%- (i -‘\
Building owner
DESCRIPTION OF WORK
# OF UNITS
Name: Brewer
Phone: 924-7092
Fax:
TOTAL AMOUNT
Address: SAME
City:
State:
Zip:
Contractor
$6.00
=
Name: Norm's Excavating, Tnc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradale State:
WA
Zip: 99037
License No: NORMSE1972BM
City Business License No:
Contact
X
$6.00
=
Name: Sheila Gibbons
Phone: 928-0580
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
AUTHORIZED SIGNATURE:
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REVISED 8/26105
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY. FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
86,00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
86.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
86.00
=
11
FLOOR DRAINS
AREA, CASE. COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
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
$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
$6.00
=
18
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
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH ❑ CHECK
Card# See Cover Sheet
EI VISA ❑ MASTERCARD
EXPIRES:
SUBTOTAL
6.00
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
14.00
AUTHORIZED SIGNATURE:
t,'d ?F4,n7aaanc
gI I T n on onv111..
REVISED 8/26105