2004, 02-25 Permit App: BLD-04-03628 Plumbing Reversal60'30Fid 22120 268 605
SPcane
z:.
Mail or Fax To: Norm's Excavatio
PO Box 574
Veradale, WA 99037
FAX: 892-0432
PLUMBING PERMIT APPLICATION
SS:S1 12002 122 83d
004,
(Hr .3&
PROJECT
ADDRESS:
OWNER:
I1(42/� C PRn i A) A
<7/ Li S
'MAILING ADORESs:
SAME
CONTRACTOR:
Belknap Plumbing
MAIUNG ADDRESS:
PERMIT
USE:
PHONE (Daytime Contact):
jstreet)
(city/slate)
(zP)
UCENSE 0:
BELKNP*071 D6
3414 S. Adams Rd.
(street)
PHONE s:
921-5913
Verdale, WA
(city/state)
99037
(zip)
PLUMBU IO FIXTURES
1
2
3
4
5
DESCRIPTION
TOILETS •
URINALS
TUBS
DETAILS
! 0P UNITS
X
COST
EQUALS
WATER CLOSET, BIDETS
x
X
SHOWERS (PER TRAP)
SINKS
BATH. STALL, ON-SITE BUILT
X
LAYS/BASINS, BAR, FLOOR.
KITCHEN, LAUNDRY, UTILITY.
.JANITOR, PHOTO, X-RAY, FOOD,
PREPICUUNARYIMEAT
X
56
56
56
56
56
6
7
B
9
10
11
DISHWASHER
x
CLOTHES WASHER
x
d V .1 0
A 3 h 2
C In—
?i a
AMOUN, E 3 m
12"2“23
m. L2 c N
It cov,
o momo
u z
Icy 0 e o
E d :E4 4^
u a 82
q u Y
.o v
c a • e
y a m
Igc"�9
t3.a
s6
56
GARBAGE DISPOSAL
WATER SOFTENER
X
r
56
X
$6
ELEC HOT WATER TANK
FLOOR DRAINS
NOTE: IF GAS SEE MECHANICAL
X
•
•
sal
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
12
13
14
15
16
17
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN
WASTE. VENT.
PLUMBING REVERSAL.
18
19
20
SEWAGE EJECTOR
INSTALLATION, ALTERATION.
REPAIR, REVERSALS
x
X
56
•
r
56
E
0
56
GRINDER. SUMP PUMP
X
WATER USING DEVICE
CROSS CONNECTION
DEVICE
SPRINKLER SYSTEM
INTERCEPTORS
MEDICAL GAS pet outlet
MISC PLUMBING FIXTURE
ICE AND/OR COFFEE MAKER.
HOSE 818, STEAMER PROOFER,
CARBONATOR, SWAMP COOLER
VACUUM BREAKER CHECK
VALVE, AND R.P.BP.O. FOR
VATS, SUMPS, TANKS, BOILERS
GREASE TRAP. SAND TRAP,
CHEMICAL. HOLDING TANK
NITROUS, OXYGEN
MAUI
❑ CASH ❑ CHEM ®same❑
re= moan WILL
RfArico T! _
D11111 veneer
DATE:
BANICARD NIYMBIIl:
REDACTED
1FDACTTEDJ_
rr...nnnan rrrM a Tr m 6T<�/y/ — T iv0
6d WdTO:P0 7002 P? 'clad 22120 268 60S : :ON XFi3
X
X
X
X
X
X
:8
38
•
Lo .60
58
$25
58
58
56
•
•
SUBTOTAL
PLUS PROCESSING
FEE
TOTAL PERMIT FEE
DUE
$35.00
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