2012, 06-26 Permit App: BLD-2012-0978 Plumbing FixturesPermit Center
S n'e ` 11707 E Sprague Ave, Suite 106
j Valley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037 PERMIT FEE:032 o
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Plumbing Permit Application n Commercial ® Residential
Mail or Fax To:
Norm's Excavating, Inc. 00178'0N
PO Box 574
Veradale, WA 99037
Fax: 892-0432
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PERMIT NUMBER:
SITE ADDRESS: 1919 N Long Rd
Building owner
Name: Alkier
Address: SAME
Contractor
Phone: 924-7763 Fax:
City:
State: Zip:
Name: Norm's Excavating, Inc
Address: PO Box 574
Phone: 509/928-0580 Fax: 509/892-0432
City : Veradale State: WA Zip: 99037
License No: NORMSE1972BM
Contact
City Business License No:
Name: Sheila Gibbons
Phone: 928-0580
AUTHORIZED SIGNATURE: , f /
REVISED 8/26/05
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DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
=
6.00
1
URINALS
X
$6.00
=
2
TUBS
X
$6.00
=
_
3
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
$6.00
=
6.00
4
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, 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
56.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6,00
=
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
$6.00
-
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
$6.00
=
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
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK El VISA ❑ MASTERCARD
FXPIRES:
SUBTOTAL
24.00
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
32.00
AUTHORIZED SIGNATURE: , f /
REVISED 8/26/05
/.-d 2F'171-12RRFnq 2ux4eneoxR sw-iou e6S:G0 21 90 unr