2012, 09-18 Permit App: BLD-2012-1613 Plumbing FixturesPermit Center
-*Mane
....1gVaHey
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development Nvw .snokanevall ev ore, corn
Plumbing Permit Application
Mail or Fax To:
'
Norm's Excavating, Inc. ti666 0 N
PO Box 574
Veradale, WA 99037
Fax: 892-0432
n
NA/Et:6 1.0Z8 "S w!J_
PERMIT NUMBER: gtct-Iz
PERMIT FEE:
Commercial X4 Residential
16 k3
SITE ADDRESS: _4524 N Calvin
Building owner
DESCRIPTION OF WORK
# OF UNITS
Name: Triplett
Phone: 220-2055
Fax:
TOTAL AMOUNT
Address: SAME
TOILETS
City State:
Zip:
Contractor
56.00
-,
Name: Norm's Excavating, Inc
URINALS
Phone: 509/928-0580
Fax 509/892-0432
Addrcss: PO Box 574
56.00
City : Veradale State: WA
Zip: 99037
License No: NORMSEI972BM
TUBS
City Business License No:
Contact
$6.00
Name: Sheila Gibbons
SHOWERS (PER TRAP)
Phone: 928-0580
1
AUTHORIZED SIGNATURE:
Ce1 7p4,n7pcapnc
2uta.eAeoxq stuJou
REVISED 8/26/05
ef12:Rn 21 81 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
$6.00
4
SHOWERS (PER TRAP)
BATH, STALL ON-SITE BUILT
1
X
$6.00
6.00
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANTTOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
$6.00
=
6.00
6
DISHWASHER
X
$6.00
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
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
56.00
12
ROOF DRAINS/OVERFLOW
DRAINS
X
MOO
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
56.00
-
18
INTERCEPTORS
GREASE TRAP. SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
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:
EJ CASH 0 CHECK
Card# See Cover Sheet
SUBTOTAL
24.00
IZI VISA 0 MASTERCARD
PROCESSING FEE
8.00
EXPIRES:
TOTAL PERMIT FEE DUE:
32.00
AUTHORIZED SIGNATURE:
Ce1 7p4,n7pcapnc
2uta.eAeoxq stuJou
REVISED 8/26/05
ef12:Rn 21 81 daS