2012, 11-06 Permit App: BLD-2012-2013 PipingossioValley
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development w_soukanevaIlev.nrg.com
Plumbing Permit Application
Mali or Fax To:
Norm's Excavating. Inc.
PO Box 574
Veradale, WA 99037
Fax: 892-0432
IT Commercial
PERMIT NUMBER:
PERMIT FEE: / r-( O%$/
Residential
SITE ADDRESS: 18401 E Broadway
Building owner
DESCRIPTION OF WORK
# OF UNITS
Name: Hughes
Phone: 891-2371 Fax:
=
Address: . SAME
City: State:
Zip:
Contractor
X
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fax: 5091892-0432
Address: PO Box 574 1
City : Vandalic State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
58.00
Contact
3
Name: Sheila Gibbons
Phone: 928-0580
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DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS ,
X
56.00
=
2
URINALS
X
58.00
=
3
TUBS
X
56.00
=
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 I
X
56.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
i
X
58.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICALI
X
$6.00
=
11
FLOOR DRAINSI
AREA, CASE, COIL TRENCH, CONDENSATE
X
56.00
=
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
56.00
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP 1
X
56.00
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 i
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR:
X
515.00
=
METHOD OF PAYMENT:
El !CASH
Card# See Cover
AUTHORIZED SIGNATURE:
0 CHECK El VISA 9 MASTERCARD
Sheet EXPIRES:
.: , 4 C / fir 44, : = -;
SUBTOTAL
6.00
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
14.00
REVISED &/2605
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