2012, 03-01 Permit App: BLD-2012-0073 Plumbing Fixtures Mail or Fax To:
Norm's Excavating,Inc. E6179 '91 Wb'S Z :6 Z l o Z '1,Z M a lu i I pan! a 3 a
, PO Box 574
Permit Center Veradale,WA 99037
l`or'an 11707 E Sprague Ave,Suitc 106 Fax 892-0432
i�s� PERMIT NUMBER: 5/C�'/z-I
�j al Spokane Valley,WA 99206 �Q
Valley (509)688-0036 FAX:(509)688-0037 PERMIT rte: r." G�7t 2C
Community Development www.spokanevalIey.org.corn
Plumbing Permit Application ❑ Commercial ® Residential
SITE ADDRESS: 14915 E Rockwell
Banding owner
Name: Blackman Phone:924-3424 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
2 URINALS X $6.00 - =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X $6.00 = 6.00
LAVS/BASINS,BAR.FLOOR,KITCHEN,
S SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 _
X-RAY,FOOD,PREP/CULINARY MEAT 1 6.00
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
12 DRAINS X $6.00 =
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 $6.00 =
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 =
20 FIXTURE
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00
INDUSTRIAL WASTE X $15.00 =
22 INTERCEPTOR
SUBTOTAL
METHOD OF PAYMENT: 24.00
PROCESSING FEE
0 CASH 0 CHECK ® VISA 0 MASTERCARD
Carat See fax cover EXPIRES: 0312012 TOTAL PERMIT FEE DUE: 24.00
AUTHORIZED SIGNATURE: --..__...._ '€ l,/lr is J REVISED 8/26/05
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