2011, 10-11 Permit App: 11003217 Plumbing Fixtures4 ,
�_ Permit Center
SOCALe 11707 E Sprague Ave, Suite 106
S"Valley Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
Community Development we_w.spnkancvallcy.org.conl
Plumbing Permit Application
SITE ADDRESS: 6125 E Moreland
Mall or Fax To: 0
Norm's Excavating, Ina} y L 8 ti N W
PO Box 574
Veradale, WA 99037
Fax: 892-0432
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PERMIT NUMBER: I 1 -3 Zi
PERMIT FEE: 3
❑ Commercial ® Residential
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Building owner
DESCRIPTION OF WORK
Name: Just
Phone: 455-7722 Fax:
COST
Address: SAME
City: State:
Zip:
Contractor
WATER CLOSET, BIDETS
Name: Norm'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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2E17OZ6860S
2ur4.eneox3 stuJoJ
REVISED 1/26/05
e9S:80 TT TT 400
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
56.00
=
3
TUBS
X
56.00
=
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
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
56.00
=
B
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
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
56.00
=
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
56.00
=
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
$6.00
=
21
PRIVATE SEWAGE DISPOSAIJSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card# See Cover Sheet
SUBTOTAL
6.00
® VISA 0 MASTERCARD
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
6.00
AUTHORIZED SIGNATURE:
t••d
2E17OZ6860S
2ur4.eneox3 stuJoJ
REVISED 1/26/05
e9S:80 TT TT 400