2011, 09-13 Permit App: 11002846 ROW, Sewer, Plumbing Fixtures Mail or Fax To:
Norm's Excavating,Inc. 261717 '°1\1( Wti'6 l l UE ld as awl1 Pa n a a
PO Box 574
lsaPermit Center Veradale,WA 99037
5#6kane
a 11707 E Sprague Ave,Suite 106 Fax:892-0432 PERMIT NUMBER:
..000Valley Spokane Valley,WA 99206
Vclll (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokancvallev.ore.com
Plumbing Permit Application n Commercial ® Residential
SITE ADDRESS: 14004 E Sharp
Building owner
Name: Ricketts Phone: 994-0243 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
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = 6.00
X-RAY,FOOD,PREP/CULINARY MEAT 1
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
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT: 24.00
PROCESSING FEE
0 CASH ❑ CHECK ® VISA ❑ MASTERCARD
Card#see cover sheet EXPIRES: TOTAL PERMIT FEE DUE: 24,00
AUTHORIZED SIGNATURE: ---__.__.. ,'•c.6 (--67.,/,,q.,;,,, - REVISED 8/26/05
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8D17 '0N—WVD:6 —IIOZ 8l 'dag auii1 paniapq
Call 24 hours before inspection required I �J c/c
Phone 509.688-0195 Fax 509.688-0037 cc,, D l0
*bile. 3q
jley DEPARTMENT OF PUBLIC WORKS
Anticipated start date 9-20-2011 Permit it Account# 000122
ROW CONSTRUCTION PERMIT
Location of property 14004 E Sharp
(Address/Parcel#, if available)
Applicant Name Ricketts
Address Same Fax 892-0432
Contractor's Name Norm's Excavating. Inc.
Address PO Box 574 Veradale.WA 99037 Phone 509/928-0580
Contractor's Reg# NORMSEI972BM Expires 01/14/13
PROJECT DESCRIPTION(Provide site sketch or plan as necessary for clarity)
x Sewer Connection n Driveway
n Curb&Gutter n Gas Installation/Repair
nCable/Conduit/Pole ❑ Sidewalk Repair/Construction
n Other
ElPavement Cut Dimensions
Bond/insurance certification must be on file with the City.Bond# 103957298
SPECIAL CONDITIONS:
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# see cover sheet_ Expiration Date
Name of Holder Signature
Fees Paid$ 110.00 Date !nit
(Application) (Inspection)
In addition to the permit application fee of$16.00(utility)or$25.00(construction), inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE
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