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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 d6Z:6 IIOZ ll'��O a�!1 p1Aiap1 PERMIT NUMBER: I 1 -3 Zi PERMIT FEE: 3 ❑ Commercial ® Residential zsZ.09 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: t••d 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