2011, 09-06 Permit App: 11002761 Plumbing FixturesStiog5;1117N*846.
Permit Center
11707 E Sprague Ave, Suite 106
0.0 ValleY Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development wv,w,spokanovallev_or....com
Plumbing Permit Application
Mall or Fax To:
Norm's Excavating, Inc.
PO Box 574
Veradale, WA 99037
Fax: 892-0432
00E17.°N AV91:01 11H .(1S ni!J_ PA!°4
PERMIT NUMBER 0769
PERMIT FEE:
(ol
ri Commercial Z Residential
SITE ADDRESS: 2610 N Dick
Building owner
DESCRIPTION OF WORK
Name: Burgerson
Phone: 926-7705
Fax:
Address: SAME
City: State:
Zip:
Contractor
WATER CLOSET, BIDETS
1
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City : Veradalc State: WA
Zip: 99037
License No: NORMSE1972BM
City Business License No:
X
Contact
Name: Sheila Gibbons
Phone: 928-0580
-
AUTHORIZED SIGNATURE:
•
REVISED 8/26/05
2uTzeneox.4 SUJJOLI e24:Rn 11 911 daS
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
56.00
=
6.00
2
URINALS
X
56.00
3
TUBS
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, FOOD, PREP/CULINARY MEAT
1
X
56.00
=
6.00
8
DISHWASHER
X
$6.00
-
7
CLOTHES WASHER
X
66.00
=
8
GARBAGE DISPOSAL
X
56.00
-
9
WATERSOFTENER
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
86.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
13
FOUNTAINS, DRINKING
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
56.00
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
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 RP.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 outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
21
PRIVATE SEWAGE OISPOSAUSYS
X
520.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK ISI VISA 0 MASTERCARD
Card t see cover sheet EXPIRES:
_
SUBTOTAL
24,00
PROCESSING FEE
37.00
TOTAL PERMIT FEE DUE:
61.00
-
AUTHORIZED SIGNATURE:
•
REVISED 8/26/05
2uTzeneox.4 SUJJOLI e24:Rn 11 911 daS