2011, 10-04 Permit App: 11003119 ROW, Plumbing Fixtures1
SpOkan
.0,00 Val ley
Community Development
Plumbing Permit
Permit Center ,
11707 E Sprague Ave, Suite 106
Spokane Valley, IVA 99206
(509)688-0036 FAX: (509)688-0037
Application
SITE ADDRESS: 6911 E Marietta
Mail or Fax To:
Norm's Excavating, Inc. 9 Lti 0
PO Box 574
Veradale, WA 99037
Fax: 892-0432
❑ Commercial
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PERMIT NUMBER:
PERMIT FEE:
Residential
Building owner
Name: Bourquin
Address: SAME
Phone: 926-1418
Contractor
Name: Norm's Excavating, Inc
Address: PO Box 574
License No: NORMSE1972BM
Contact
Name: Sheila Gibbons
City:
Phone: 509/928-0580
City : Veradale
Fax:
State:
State: WA
City Business License No:
Phone: 928-0580
Zip:
Fax: 509/892-0432
Zip: 99037
DESCRIPTION OF WORK
1
2
3
4
TOILETS
URINALS
TUBS
WATER CLOSET, BIDETS
# OF UNITS
1
X
X
COST
$6.00
TOTAL AMOUNT
6.00
X
56.00
X
$6.00
SHOWERS (PER TRAP)
5
SINKS
6
7
DISHWASHER
BATH, STALL, ON-SITE BUILT
1
X
$6.00
6.00
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
X
$6.00
6.00
X
$6.00
CLOTHES WASHER
x
$6.00
8
9
10
11
12
13
14
15
16
GARBAGE DISPOSAL
WATER SOFTENER
X
$6.00
X
$6.00
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW
DRAINS
FOUNTAINS, DRINKING
NOTE: IF GAS, SEE MECHANICAL
x
$6.00
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
X
56.00
X
$6.00
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
56.00
6.00
WATER USING DEVICE
17
18
19
20
21
22
CROSS CONNECTION DEVICE
INTERCEPTORS
GRINDER, SUMP PUMP
X
56.00
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS. BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
X
$6.00
X
56.00
MEDICAL GAS (per outiet)
NITROUS, OXYGEN
x
56.00
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
INTERCEPTOR
X
520.00
X
$15.00
METHOD OF PAYMENT:
0 CASH 0 CHECK
Card# See Cover Sheet
AUTHORIZED SIGNATURE:
•d
® VISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
24.00
PROCESSING FEE
TOTAL PERMIT FEE DUE:
24.00
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REVISED 8/26/05
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