2012, 10-02 Permit App: BLD-2012-1711 PipingPermit Center
Spokane 11707 E Sprague Ave, Suite 106
assoaelCDalley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development ,‘ w.v .,pnkanevnllev.ole.com
Plumbing Permit Application
Mail or Fax To:
None's Excavating. Inc.
PO Box 574
Veradale, WA 99037
Fax 892-0432
0 -?o) 7-- '1
9810'°N WVL6:01 blob 130 awil pAl23aa
PERMIT NUMBER:
PERMIT FEE:
n Commercial ® Residential
SITE ADDRESS: _19222 E Mission
Building owner
DESCRIPTION OF WORK
Name: Unice
Phone: 926-5982 Fax,
COST
Address: SAME
City: State:
Zip:
Contractor
WATER CLOSET. BIDETS
Name: Norm's Excavating, Inc
Phone: 509/928-0580
Fav: 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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UneAEOX3 SWJOI,J
REVISED 11I26/05
eET:OT at Zo 4°o
DESCRIPTION OF WORK
# OF UNITS
X
COST
a
TOTAL AMOUNT
1
TOILETS
WATER CLOSET. BIDETS
X
5600
=
2
URINALS
X
56.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
36 00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
5600
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
5600
=
9
WATER SOFTENER
X
5800
=
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
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
5600
=
6.00
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
58.00
=
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
5600
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK E1 VISA 0 MASTERCARD
Card# See Cover Sheet EXPIRES:
SUBTOTAL
6.00
PROCESSING FEE
8.00
TOTAL PERMIT FEE DUE:
14.00
AUTHORIZED SIGNATURE:
r/,
z d E170a88GO9
UneAEOX3 SWJOI,J
REVISED 11I26/05
eET:OT at Zo 4°o