2011, 10-25 Permit App: 11003396 Plumbing Fixtures • Mail or Fax To: o 7 ';p101a i a
Norm's Excavating,Inc. Z l S N NV L S '6 l l H Z S7LLI!.[ Pnaa
PO Box 574
Permit Center Veradale,WA 99037
Siler e` 11707 E Sprague Ave,Suite 106 Fax 892-0432 PERMIT NUMBER:
Spokane Valley,WA 99206
.000Fvalley (509)688-0036 FAX:(509)688-0037 PERMIT FEE: I--
Community Development %VW%%.spokancvallcv=ore.com
Plumbing Permit Application ❑ Commercial ® Residential
SITE ADDRESS: 14805 E Rockwell
Building owner
Name: Yocum Phone: Fax:
Address: SAME City: State: Zip:
Contractor
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:
Contact
Name: Sheila Gibbons Phone: 928-0580
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET.BIDETS 1 X $6.00 = 6.00
X
2 URINALS $6.00 =
3 TUBS 1 X $6.00 = 6.00
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
LAYS/BASINS,BAR,FLOOR,KITCHEN, 6 00
5 SINKS LAUNDRY.UTILITY,JANITOR,PHOTO, 1 X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS.SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6.00 =
ROOF DRAINS/OVERFLOW X $6.00
12 DRAINS
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS 1 X $6.00 = 6.00
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
VACUUM BREAKER.CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS.TANKS,BOILERS X 56.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING X $6.00 =
20 FIXTURE
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 =
INDUSTRIAL WASTE X $15.00 =
22 INTERCEPTOR
SUBTOTAL
24.00
METHOD OF PAYMENT: PROCESSING FEE
❑ CASH 0 CHECK ® VISA 0 MASTERCARD 37.00
Card#see cover sheet EXPIRES: TOTAL PERMIT FEE DUE: 61.00
AUTHORIZED SIGNATURE: :•, 1, .''-' ' ,/r( REVISED 826/05
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