2012, 07-10 Permit App: BLD-2012-1066 PipingPermit Center
.Spokane 11707 E Sprague Ave, Suite 106
jUalley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development .i ii ,pok:in. :iIk,.,,re u,in
Plumbing Permit Application
Mail or Fax To: r1 0
Norm's Excavating, Inc 16E 5 N
PO Box 574
Veradale, WA 99037
Fax. 892-0432
❑ Commercial
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PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS: 18615 E Mission
Building owner
DESCRIPTION OF WORK
Name: Schelley Phone: 926-3333 Fax.
X
COST
Address: SAME
City: State
Zip.
Contractor
WATER CLOSET, BIDETS
Name: Nomr's Excavating, Inc
Phone: 509/928-0580
Fax: 509/892-0432
Address: PO Box 574
City: Veradale State: WA
Zip: 99037
License No: NORMSEI972BM
City Business License No:
X
Contact
=
Name: Sheila Gibbons
Phone 928-0580
AUTHORIZED SIGNATURE:
/
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REVISED 8R6/05
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DESCRIPTION OF WORK
11 OF UNITS
X
COST
L=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
2
URINALS
X
$6.00
=
3
TUBS
X
58.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
56.00
=
6
DISHWASHER
X
$6 00
=
7
CLOTHES WASHER
X
$600
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS. SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE. COIL, TRENCH CONDENSATE
X
56 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
$6.00
=
600
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
'
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
5600
=
18
INTERCEPTORS
GREASE TRAP. SAND TRAP,
CHEMICAL HOLDING TANK
X
56 00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING
FIXTURE
.X
$600
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK ® VISA 0 MASTERCARD
Card# See Cover Sheet EXPIRES:
SUBTOTAL
6.00
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
14.00
AUTHORIZED SIGNATURE:
/
C -d ZEb026B60S
2utq.eneox3 swuoN
REVISED 8R6/05
e?E=60 ZT GT InC