2012, 07-10 Permit App: BLD-2012-1065 Plumbing Fixtures R
Norm's Excavating,Inc. l6S8 '°N Wb'OS :6 MI6 'ol 'Inr awil pan ! ana
POBox 574 P
Permit Center Veradale,WA 99037 ft, � ~_� Z LC) •S---
Spokane 11707 E Sprague Ave,Suite 106 Fax:892-0432
�% JJey Spokane Valley,WA 99206 PERMIT NUMBER:
. (509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development �_��:.;pokan %all_e oro.com
Plumbing Permit Application n Commercial ® Residential
SITE ADDRESS: 4615 N Vercler
Building owner
Name: Goll Phone: 891-1498 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:NORMSE1972BM 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,KffCHEN,
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 DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X $15.00
SUBTOTAL
METHOD OF PAYMENT: _ 24.00
PROCESSING FEE
0 CASH Cl CHECK ® VISA ❑ MASTERCARD _ 37.00 _
Card# See Cover Sheet A EXPIRES: TOTAL PERMIT FEE DUE: 61.00
•
AUTHORIZED SIGNATURE: Or- �' '. �. •. 1SED8/26!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 GS2014-030.
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