2011, 11-08 Permit App: 11003550 ROW, Plumbing Fixturesiley
Community Development
Plumbing Permit
Permit Center
11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688.0036 FAX: (509)688-0037
waw.spokanevalleV.ore. com
Application
SITE ADDRESS:
4617 N Woodlawn
Mall or Fax To:,
Non's Excavating. Inc.
PO Box 574
Veradale, WA 99037
Fax 892-0432
Commercial
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Residential
Building owner
Name: Wilson
Address: SAME
Contractor
Name: Norm's Excavating, Inc
Address: p0 Box 574
License No: NORMSEI97213M
Contact
Name: Sheila Gibbons
Phone: 927-0102
LILY:
Phone: 509/928-0580
City: Veradale
Fax
Stale: Zip:
Fax: 509/892-0432
State: WA Zip: 99037
City Business license No:
Phone: 928-0580
Card, See Cover Sheet
AUTHORIZED SIGNATURE:
a • d
z640Z686OS
2ut3eneoX3 stuJob
REVISED 8/26/05
eb6:60 II 80 A014
DESCRIPTION OF WORK
WATER CLOSET, BIDETS
BATH. STALL, ONSITE BUILT
LAVSBASINS, BAR, FLOOR. KITCHEN,
LAUNDRY. UTILITY, JANITOR. PHOTO.
X -RAV FOOD PREP/CULINARY MEAT
OF UNITS
1
1
1
X
X
X
X
X
X
COST
56.00
$6 �
$6.00
56.00
56.00
=
=
_
-
=
=
TOTAL AMOUNT -
6.00
6.00
6.00
1
TOILETS
2
URINALS
3
TUBS
4
SHOWERS (PER TRAP)
5
SINKS
X
36.00
=
6
DISHWASHER
X
36.00
=
7
CLOTHES WASHER
- X
36.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
NOTE: IF GAS, SEE MECHANICAL
X
56.00
_
10
ELECTRIC HOT WATER TANK
AREA CASE, COIL TRENCH CONDENSATE
X
36.00
=
11
FLOOR DRAINS
ROOF DRAINS/OVERFLOW
X
$6.00
-
12
DRAINS
X
36.00
=
13
FOUETAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
REPAIR,
NS7ALLATOR, ALTERREVERSALS
REVERSALS
1
X
$6.00
=
6.00
14
VENT PLUMBING, REVERSAL
PLUMBING,
GRINDER, SUMPPUMP
X
56.00
=
15
16
SEWAGE EJECTOR
WATER USING DEVICE
ICE ANIOR COFFEE MAKER. HOSE BIB.
STEAMER
PROOFER, CARBONATOR, SWPMP COOLER
X
� �
_
VACUUM BREAKER, CHECK VALVE,
AND R.PGREASE
X�
_
17
CROSS CONNECTION DEVICE
TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
18
INTERCEPTORS
NITROUS, OXYGEN
X
56.00
=
19
20
MEDICAL GAS (Per outlet)
MISCELLANEOUS PLUMBING
FIXTURE
X X
OD
$6. 36.320.00
=
=
21
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
X
515.00
=
22
INTERCEPTOR
METHOD OF PAYMENT:
0 CASH 0 CHECK
0 VISA 0 MASTERCARD
e-
SUBTOTAL
24.00
PROCESSING FEE
TOTAL PERMIT FEE DUE
24.00avula
Card, See Cover Sheet
AUTHORIZED SIGNATURE:
a • d
z640Z686OS
2ut3eneoX3 stuJob
REVISED 8/26/05
eb6:60 II 80 A014