2012, 04-17 Permit App: BLD-2012-0407 Plumbing Fixtures Nouns Excava IIZL '°N WdSZ 6 6lH 'Ll 'ady a�!1 paAla�a�
Norm's Excavating,Inc.
PO Boz 574
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7'��` Permit Center Veradale,WA 99037 610- ZO/2 -45417
Ane 11707 E Sprague Ave,Suite 106 Fax:892-0432
rn00,00Valley Spokane Valley,WA 99206 PERMIT NUMBER:
(509)688-0036 FAX:(509)688-0037 PERMIT PEE: 4t32 00
Community Development Www_snokaneval1ev.org.com
Plumbing Permit Application ❑ Commercial ® Residential
SITE ADDRESS: _4507 N Vercler
Building owner
Name:Sonsalla Phone:981-0748 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,
5 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
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00 -
SUBTOTAL
METHOD OF PAYMENT: 24.00
PROCESSING FEE
0 CASH ❑ CHECK SI40A ❑ MASTERCARD 8.00
Card# See Cover Sheet Ake EXPIRES: TOTAL PERMIT FEE DUE: 32.00
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AUTHORIZED SIGNATURE: �'=c v r, cr t e J REVISED 8/26/05
This document originally contained
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to SOS DAN G52014-030.
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