2004, 03-26 Permit App: BLD-04-03917 Plumbing Reversal FROM : NORM'S EXCAVATING FAX NO. : 509 892 0432 Mar. 26 2004 10:33AM P7
n Mail or Fax To: Norm' s Excavating 01/ - 3917
Spao°_ e PO Box 574
V y� Veradale, WA 99037
Y'dl FAX: 892-0432
PLUMBING PERMIT APPLICATION ,
PROJECT / /� PERMIT
ADDRESS: 10(p O 67_o /j�(1' USE:
OWNER: RO &ERS PHONE(Daytime Contact):
MAILING ADDRESS: SAME
(street) (city/state) (Z1p)
'CONTRACTOR: LICENSE#:
Belknap Plumbing BELKNP*071D6
MAILING ADDRESS: PHONE if:
921 -5913
3414 S. Adams Rd. Verdale, WA 99037
(street) (city/state) (zip)
PLUMING FIXTURES
DESCRIPTION DETAILS s Of un 1111fli X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6
2 URINALSX $6 -
3 TUBSX $6 P
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT r X $6
5 SINKS LAVS/BASINS,BAR,FLOOR. X $6
KITCHEN.LAUNDRY,UTILITY,
JANITOR.PHOTO,X-RAY.FOOD,
PREP/CUUNARYIMEAT . •
6 DISHWASHER
X • $6�_�
7 CLOTHES WASHER
8 GARBAGE DISPOSAL i X , $6 10
9 WATER SOFTENERX $6 e
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6
' 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,
$6
CONDENSATE X - __
12 FOUNTAINS,DRINKING X 6mi
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION, X $6 ' ,l ,l
WASTE,VENT, REPAIR,REVERSALS
I to` e6
. PLUMBING REVERSAL =
' 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $66 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER,
GARSONATOR,SWAMP COOLER
rov � --
d
a .Fid 18 CROSS CONNECTION VACUUM BREAKER CHECK X S6
2 L DEVICE VALVE,AND R.P.B.P.D.FOR:
c c ,.i iv VATS,SUMPS,TANKS,BOILERS ei
3 o a+ o X
—
'� 17 SPRINKLER SYSTEM
o c d v 18 INTERCEPTORS GREASE TRAP,SAND TRAP, 6
c c o n N CHEMICAL HOLDING TANK X •
'o c s i; 19 MEDICAL GAS per outlet NITROUS.OXYGEN X 6 '
Of Li = - Z 20 MISC PLUMBING FIXTURE X $6 6
o
- SUBTOTAL t�pdd
y a` eo _._—...:2;
L '° 4 0 CASH 0 CFiECIC I - d ' PLUS PROCESSING $38,00
el y d 5 c !AXED PERMITS VIII.ONLY BE ACCEPTED VTTM PAY (T FEE
: L 3 OP A MAJOR CREDIT CARD
= ( ) TOTAL PERMIT FEE ill til),
•
.._ . > `oa �UE
DATE: Se.0Ar EJQ'1 �� •
-
BANSCARD NUMBER: —
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