2011, 10-11 Permit App 11003218 DrainPermit Center
Spokane 11707 E Sprague Ave, Suite 106
Valle Spokane Valley, WA 99206
y (509)688-0036 FAX: (509)688-0037
Community Development «. 1'W.Spokancval ley. nrg.com
Plumbing Permit Application
Mail or Fax To:
Norm's Excavating, Inca L 81b '° N WV 6 6. 6 l l O Z l l' P 0 a u] i 1 p I A! a a d
PO Box 574
Veradale, WA 99037
Fax: 892-0432
PERMIT NUMBER It — 3 Z 0
PERMIT FEE: .73 �y
❑ Commercial ® Residential
SITE ADDRESS: 2216 N Coleman
Building owner
Name: Kingsley
Phone: 921-2792
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
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH. STALL. ON -SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR. PHOTO,
X-RAY. FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOTWATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA. CASE, COIL. TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING. REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
1
X
$6.00
=
6.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR. SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK
Card# See Cover Sheet
SUBTOTAL
6.00
1I VISA 0 MASTERCARD
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
6.00
AUTHORIZED SIGNATURE:
REVISED S/26/05
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