2013, 03-25 Permit App: BLD-2013-0492 Sewer Reversal Mail or Fax To:
Norm's Excavating,Inc.
P.O.Box 3 el D, �f wuC , O(Jc7 j
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Permit Center Spokane.WAA99 5223 !� 7
Sokaneav• N11707 E Sprague Ave,Suite 106 Fax: 5091448-4906 PERMIT NUMBER:
Spokane Valley,WA 99206 Finail-Tina/nhnnrmgewravatinn rnm
(509)688-0036 FAX:(509)688-0037 PERMIT FEE: 1(,pQ
Community Development �c•.vw.spokanevallcy.or�a>m
Plumbing Permit Application E Commercial E Residential
SITE ADDRESS: 13804 E Wellesley
Building owner
Name: Schmike Phone: Fax:
Zip:99223
Address:
SAME City: State: Zip:509/448-4906
State: WA
Fax:
Contractor
Name: Norm's Excavating.Inc Phone: 509/928-0580
Address: PO Box 30873 City:Spokane
License No:NORMSEI972BM City Business License No:
Con tact
Name: Tina Lingo Phone: 928-0580
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X 56.00 =
2 URINALS X 56.00 =
3 TUBS X S6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
LAVSIBASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT _
6 DISHWASHERX $6.00 =
7 CLOTHES WASHERX $6.00 =
8 GARBAGE DISPOSALX $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 56.00 = 6.00
t 15 SEWAGE EJECTOR GRINDER,SUMP PUMP ,X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER X $6.00i =
PROOFER CARBONATOR,SWAMP COOLER . I
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 66.00 =
16 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING
20 FIXTUREX $6.00 =
21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 =
INDUSTRIAL WASTE X $15.00 =
22 i INTERCEPTOR
SUBTOTAL
METHOD OF PAYMENT: 6.00
PROCESSING FEE
0 CASH ❑ CHEC ® ISA 0 MASTERCARD 8.00
Card# See fax cover . .'1 S: TOTAL PERMIT FEE DUE: 14.00
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AUTHORIZED SIGNATURF� i%� KEvIsEDs126'05
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 G52014-030.
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