2012, 07-24 Permit App: BLD-2012-1179 Plumbing Fixtures a Mail or Fax 7o: 9 8 o Wd�� 8 606tiZ inr awil pan ! DI
• Norm's Excavating,Inc. U
PO Box 574
Permit Center Veradale,WA 99037
SM,�,,,"ka�a 11707E Sprague Ave,Suite 106 Fax:892-0432
Dalley Spokane Val ey,WA 99206 PERMIT NUMBER: E - 12- i i 7
(509)688-0036 FAX:(509)688-0037 PERMIT FEE:
Community Development w‘t\%.1poknn Nall.n.Or_.COmz
Plumbing Permit Application n Commercial M Residential /rie
SITE ADDRESS: 1112 S Warren
Building owner
Name: McAndrew Phone: 928-0574 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
LAYS/BASINS,BAR,FLOOR,KITCHEN,
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 ❑ CHECK ® VISA ❑ MASTERCARD 8.00
Card# See Cover Sheet ExpIRES: TOTAL PERMIT FEE DUE: 32.00
R .okcr ,,
AUTHORIZED SIGNATURE: This document originally contained REVISED 8t261°5
confidential credit card information which
was redacted pursuant to RCW 19.255.010
and the original document destroyed
pursuant to 505 DAN G52014-030.
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