2012, 03-05 Permit App: BLD-2012-0079 Plumbing Fixtures ••'.6 . • Mall or Fax To:
Norm's Excavating,Inc. E099 '°Ni WdSti'6 M)6 'l 'a W awil pani a°a
POBox574 61„pU- 202 —0079
T ermit Center Veradale,WA 99037
Spoke_ 11707E Sprague Ave,Suite 106 Fax:892-0432 PERMIT NUMBER:
�` lley <,pokane Valley,WA 99206
V-d 009)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development ,_wwmoknnevallev.oro corn
Plumbing Permit Application ❑ Commercial ® Residential
SITE ADDRESS; 1419 S Warren
Building owner
Name: Bess Phone: 921-2242 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
4
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
LAVSBASINS,BAR,FLOOR.KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, 1 X $6.00 = 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 WATEF 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,DRINKINC X $6.00
WATER PIPING/DRAIN-N 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 )EVICE 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
❑ CASH ❑ CHECK ® VI CI MASTERCARD 37.00
Card# See fax cover ,1( PIRES:03/2012 TOTAL PERMIT FEE DUE: 61.00
AUTHORIZED SIGNATURE: w :. -,...../' /,.�l ` ,,,17"', REVISED 8/26105
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.
c •nl c.i.naaanc 2uzaeneox1 SWJO1J B22 :lli 21 IO Jew