2012, 08-14 Permit App: BLD-2012-1308 Plumbing Fixtures.�
Spokane
Valley
Community Development
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
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Mail or Fax To:
Norm's Excavating, Inc.
PO Box 574
Veradale, WA 99037
Fax: 892-0432
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Plumbing Permit Application D Commercial
SITE ADDRESS: _4419 N Ellen
PERMIT NUMBER:
PERMIT FEE: it
® Residential
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Building owner
Name: Emmerson
Address: SAME
Contractor
Name: Norm's Excavating, Inc
Address: PO Box 574
License No: NORMSE1972BM
Contact
Name: Sheila Gibbons
Phone: 290-9208
City:
Phone: 509/928-0580
City : Veradale
Fax:
State:
State: WA
City Business License No:
Phone: 928-0580
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card# See Cover Sheet
EFS
BUILT
, KITCHEN,
R, PHOTO,
ARY MEAT
:HANICAL
CONDENSATE
N, REPAIR,
SUMP
R, HOSE BIB,
WAMP COOLER
.CK VALVE,
TANKS, BOILERS
D TRAP,
3 TANK
EN
® VISA 0 MASTERCARD
EXPIRES:
AUTHORIZED SIGNATURE:
2•d
zEb'o2G86O
# OF UNITS
1
X
X
X
X
X
Zip:
Fax: 509/892-0432
X
X
X
X
X
X
X
X
X
x
X
X
X
X
X
X
X
X
Zip: 99037
COST
$6.00
$6.00
$6.00
56.00
$6.00
56.00
$6.00
56.00
56.00
56.00
56.00
56.00
$6.00
56.00
56.00
56.00
56.00
$6.00
56.00
$6.00
$20.00
515.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
Ui.eneox3 SWJOk1
TOTAL AMOUNT
6.00
6.00
8.00
14.00
REVISED 8/26/05
ec0=01 ZI 211E1
DESCRIPTION OF WORK
WATER CLOSET, BIC
1
TOILETS
2
URINALS
3
TUBS
BATH, STALL, ON-SITE
4
SHOWERS (PER TRAP)
LAVS/BASINS, BAR, FLOOF
5
SINKS
LAUNDRY, UTILITY, JANET(
X-RAY, FOOD, PREPICUUL
6
DISHWASHER
7
CLOTHES WASHER
8
GARBAGE DISPOSAL
9
WATER SOFTENER
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MEI
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
ROOF DRAINS/OVERFLOW
12
DRAINS
13
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
NSTALLATION, ALL SI
14
VENT, PLUMBING, REVERSAL
RSA
F
15
SEWAGE EJECTOR
GRINDER, SUMP
ICE AN/OR COFFEE MAKE
16
WATER USING DEVICE
STEAMER
5
PROOFER, CARBONATOR,
VACUUM BREAKER. CHI
17
CROSS CONNECTION DEVICE
AND R.P.B.P.D.GREFOR:E VATS,
SAN
18
INTERCEPTORS
CHEMICAL HOLDIN
19
MEDICAL GAS (per outlet)
NITROUS, OXY(
MISCELLANEOUS PLUMBING
20
FIXTURE
21
PRIVATE SEWAGE DISPOSAUSYS
INDUSTRIAL WASTE
22
INTERCEPTOR
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card# See Cover Sheet
EFS
BUILT
, KITCHEN,
R, PHOTO,
ARY MEAT
:HANICAL
CONDENSATE
N, REPAIR,
SUMP
R, HOSE BIB,
WAMP COOLER
.CK VALVE,
TANKS, BOILERS
D TRAP,
3 TANK
EN
® VISA 0 MASTERCARD
EXPIRES:
AUTHORIZED SIGNATURE:
2•d
zEb'o2G86O
# OF UNITS
1
X
X
X
X
X
Zip:
Fax: 509/892-0432
X
X
X
X
X
X
X
X
X
x
X
X
X
X
X
X
X
X
Zip: 99037
COST
$6.00
$6.00
$6.00
56.00
$6.00
56.00
$6.00
56.00
56.00
56.00
56.00
56.00
$6.00
56.00
56.00
56.00
56.00
$6.00
56.00
$6.00
$20.00
515.00
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
Ui.eneox3 SWJOk1
TOTAL AMOUNT
6.00
6.00
8.00
14.00
REVISED 8/26/05
ec0=01 ZI 211E1