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2012, 06-12 Permit App: BLD-2012-0862 Plumbing Fixtures Mall or Fax To: `CJ19 'ON WVOl '6 M6 'ZL 'unr ;tui' PA! ;DJ i Norms Excavating,Inc. PO Box 574 �,Op4 Permit Center Veradale,WA 99037 �� Z40/2i S" _ ne 1 11707 E Sprague Ave,Suite 106 Fax:892-0432 `� Spokane Valley,WA 99206 PERMIT NUMBER: Val ley (509)688-0036 FAX:(509)688-0037 CommunityDevelopment PERMIT FEE: 4 �j1_Q0 P n���r.�r;ol;�n_zvall �.i�r�.cx m Plumbing Permit Application ❑ Commercial ® Residential SITE ADDRESS: _1 120 S Warren Building owner Name: Lefler Phone: 928-6073 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, 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 ❑ CASH 0 CHECK YVISA 0 MASTERCARD 37.00 Card# See Cover Sheet °PCC `/ EXPIRES: TOTAL PERMIT FEE DUE: 61.00 ils --- 4„:-.. ✓ REVISED 026/05 AUTHORIZED SIGNATURE: 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. 4, •d P.p4,n2aRnnc 2uia.eneoxR swJo1..1 eiS =Bn 21 21 uff