2011, 09-01 Permit App: 11002711 ROW, Sewer, Piping Sep 01 11 09: 16a Norms Excavating 5098920432 p. 2
Mail or Fax To:
Norm's Excavating,Inc,
PO Box 574
Permit Center Veradale,WA 99037
Spokane 11707 11707 E Sprague Ave,Suite 106 Fax:892-0432
PERMIT NUMBER:
.Valley Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development www.spokanevallmoro.com
Plumbing Permit Application [l Commercial ® Residential
SITE ADDRESS: 4311 N Vercler
Building owner
Name: Robinson Phone: 892-1654 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:Vcradale 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,ON-SITE BUILT X $6.00 =
—
LAYS/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 $8.00 =
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 $8.00 =
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: 6.00
PROCESSING FEE
0 CASH 0 CHECK N VISA 0 MASTERCARD
Card#see cover sheet 49 EXPIRES TOTAL PERMIT FEE DUE: 6.00
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Received Time Sep, 1. 2 011 9: 5 3 AM N o, 4252 the original document
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