2012, 04-26 Permit App: BLD-2012-0488 Plumbing Fixtures I
Mail or Fax To:
Norm's Excavating,Inc. 9LCL '°N IWbLI Ol ZIOZ 9Z 'a ad aw11 pantapaN
PO Box 574
Permit Center Veradale,WA 99037 8c,0— 49(2- - 0 '48
Spokane 11707 E Sprague Ave,Suite 106 Fax:892-0432 PERMIT NUMBER:
400001Vai ey Spokane Valley,WA 99206
(509)688-0036 FAX:(509)688-0037
Community Development „,,,%%. l,n?:an ali \_iyg . IL: PERMIT FEE:
Plumbing Permit Application n Commercial ® Residential
SITE ADDRESS: _818 S Warren
Building owner
Name: Daubert Phone: 922-6495 I Fax:
Address: SAME City: State: Zip:
Contractor
Name: Norm's Excavating,Inc Phone: 509/928-0580 i 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 =
2 URINALS I X $6.00 . _
3 TUBS I X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 I X $6.00 =
LAVS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, 1 X $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 =
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9 WATER SOFTENER I X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE I X $6.00 =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
13 FOUNTAINS,DRINKING I X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS 1 i X $6.00 = 6.00
15 SEWAGE EJECTOR GRINDER,SUMP PUMP I X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER i 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 I X $6.00 =
GREASE TRAP,SAND TRAP, i
18 INTERCEPTORS CHEMICAL HOLDING TANK I X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING
-20 FIXTURE I 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 la VISA 0 MASTERCARD 8.00
Cards See Cover Sheet EXPIRES: TOTAL PERMIT FEE DUE: 14.00
•
AUTHORIZED SIGNATURE: -.
REVISED 8/26/05
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