2012, 06-14 Permit App: BLD-2012-0894 Piping Jun 14 1^ 03: 29p Norms Excavating 5098920432 p. 2
Mail or Fax To:
Norm's Excavating,Inc. •
PO Box 574
1 ,.�
Permit Center Veradale,WA 99037 • Ld[2•
seine 11707 E Sprague Ave,Suite 106 Fax:892-0432
....00,0Valley Spokane Valley,WA 99206 PERMIT NUMBER:
(509)688-0036 FAX:(509)688-0037iM
CommunityDevelopment PERMIT FEE: t� ( �w
Plumbing Permit Application n Commercial ® Residential
SITE ADDRESS: 4126N.Vernier
Building owner
Name: Edmonds 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 X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT X $6.00 _= _
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT _— _
6 DISHWASHER X $8.00 =
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.O.FOR: VATS,TANKS,BOILERS X $8.00 _=
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 DISPOSAUSYS X $20.00 - —
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 =
SUBTOTAL
METHOD OF PAYMENT: O 6.00
PROCESSING FEE
0 CASH 0 CHECK �db ISA ❑ MASTERCARD _ 37.00
Card# See Cover Sheet Of
EXPIRES: TOTAL PERMIT FEE DUE: 43.00
T fit` — i ' "/• •, REVISED 8/2&05
AUTHORIZED SIGNATURE:
This document original) contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
Received Time Jun. 14. 2012 3:49 PM No. 8249 and the original document destroyed
pursuant to SOS DAN GS2014-030.