2011, 09-29 Permit App: 11003066 ROW, Sewer, Plumbing Fixtures Norm s Excaxaating,Inc. 96917 '°N Wb'8 S :8 l l H '6 Z 'd S anvil p A!
i. PO Box 574
Permit Center Veradale,WA 99037
" ' ne 11707 E Sprague Ave,Suite 106 Fax:892-0432
PERMIT NUMBER:........0`Val Spokane Valley,WA 99206
v (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development NI\NSI:.silo;ane.a11c_v.or,.corn
Plumbing Permit Application ❑ Commercial ® Residential
SITE ADDRESS: 13914 E Springfield
Building owner
Name: Cambell Phone: 230-1070 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 I Zip:99037
License No:NORMSEI972BM City Business License No:
Contact •
Name: Sheila Gibbons Phone: 928-0580
I
DESCRIPTION OF WORK #OF UNITS X I COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 1 X I $6.00 = 6.00
2 URINALS X I $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,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, 1 X $6.00 = 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
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 0 CHECK ® VISA 0 MASTERCARD
Card# See Cover Sheet EXPIRES: TOTAL PERMIT FEE DUE: 24.00
AUTHORIZED SIGNATURE: /' - / "
REVISED 8/26./D5
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