2005, 03-23 Permit Application: 05000891 Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688 -0037
ir%alleY For Inspections, Call (509) 688 -0054
Project Address: /8icc/� r �! Ale '
Owner: ,^LC a /at/4, -�
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
�cwt,rr7��f
Phone (Daytime Contact):
Contractor: ,j 1 % fc),
Mailing Address:
City
Licens
yAg -7- sue i,2 ,
City
State Zip Code
Phone #: •'15� -S6 -*
G
State
Zip Code
DESCRIPTION OF WORK
1
TOILETS
WATER CLOSET, BIDETS'
2
URINALS
3
TUBS
4
SHOWERS (PER TRAP)
5
SINKS
BATH, STALL ON-SITE BUILT
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
6
DISHWASHER
7
CLOTHES WASHER
8
GARBAGE DISPOSAL
WATER SOFTENER
10
ELECTRIC HOT WATER TANK
11
12
FLOOR DRAINS
'ROOF DRAINS /OVERFLOW
DRAINS
NOTE: IF GAS, SEE MECHANICAL
AREA, CASE, COIL, TRENCH, CONDENSATE
13
14
FOUNTAINS, DRINKING
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
15
SEWAGE EJECTOR
16
WATER USING DEVICE
17
CROSS CONNECTION DEVICE
18
INTERCEPTORS
19
20
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING
FIXTURE
NSTALLATION, ALTERATION, REPAIR,
•REVERSALS
GRINDER, SUMP PUMP
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
21
22
PRIVATE SEWAGE DISPOSAL/SYS
INDUSTRIAL WASTE
INTERCEPTOR
METHOD OF PAYMENT:
CASH ❑ CHECK
• DATE: ' O�
BANKCARD NUMBER:
❑ VISA
EXPIRES:
❑ MASTERCARD
# OF UNITS
X
COST •
=
X
• $6.00
=
TOTAL AMOUNT
C)
X
56.00
=
1
X
56.00
4y�
X
56.00
=
=
/
X
56.00
=
1_ am
,l
X
56.00
=
X
56.00
X
56.00
=
X
56.00
=
X
56.00
=
X
56.00
=
6 9"U
X
56.00
X
56.00
=
X
X
$6.00
56.00
=
=
tr ■ VU
X
56.00
=
X
56.00
X
56.00
=
X
56.00 •
=
X
56.00
=
=
X
520.00
=
X
515.00
SUBTOTAL
=
3 0 cp
PROCESSING FEE
. 535.00
TOTAL PERMIT FEE DUE:
;: ‘
AUTHORIZED SIGNATURE:
Project Address:
Owner:
Mailing Address:
Contractor: License #: Phone #:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688 -0037
For Inspections, CaII (509) 688 -0054
Community Development Departmen
Building Divisior
11707 E. Sprague Avenue, Suite 10E
Spokane Valley, WA 9920E
Permit Use:
Phone (Daytime Contact):
City
State Zip Code
Mailing Address:
City
State Zip Code
2
3
4
DESCRIPTION OF WORK
# OF UNITS
X
COST
= TOTAL AMOUNT
FUEL BURNING APPLIANCE
FUEL BURNING APPLIANCE
Equal to or less than 100,000
More than 100,000
X
b t2.00
X
515.00
UNLISTED APPLIANCE (Additional Fee)
UNLISTED APPLIANCE (Additional Fee)
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
Equal to or less than 400,000
More than 400,000
X
550.00
X
5100.00
USED APPLIANCE (WSEC min. AFUE rating)
USED APPLIANCE (WSEC min. AFUE rating)
BOILER/REFRIGERATION
Equal to or less than 400,000
More than 400,000
550.00
x
5100.00
1 - 100M BTU
$12.00
BOILER/REFRIGERATION
101 - 500M BTU
X
520.00
BOILER/REFRIGERATION
501 - 1,000M BTU
X
525.00
BOILER/REFRIGERATION
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
535.00
More than 1,750M BTU
X
560.00
GAS LOG, GAS INSERT, GAS FIREPLACE
RANGE
DRYER
X
510.00
x
510.00
X
$10.00
FUEL BURNING WATER HEATER
510.00
MISC. FUEL BURNING APPLIANCE
GAS PIPING (each outlet)
DUCT SYSTEMS
X
X
510.00
51,00
X
510.00
VENTILATING FANS
X
510.00
AIR HANDLER (DOES NOT include ducting)
AIR HANDLER (DOES NOT include ducting)
EVAPORATIVE COOLERS
TYPE I HOOD
Equal to or less than 10,000 CFM
Greater than 10,000 CFM
X
512.00
515.00
X
510.00
X
550.00
TYPE II HOOD
X
510.00,
HEAT PUMP /AIR CONDITIONER
.AIR CONDITIONER
AIR CONDITIONER
0-3 TON
512.00
3 -15 TON
x
520.00
15 -30 TON
X
525.00
AIR CONDITIONER
30 -50 TON
X
535.00
AIR CONDITIONER
More than 50 TON
X
$60.00
LPG STORAGE TANK
x
510.00
WOOD OR PELLET STOVE/INSERT
35
36
37
WOOD STOVE - FREE STANDING
REPAIR & ADDITIONS
X
510.00
VENTILATION SYSTEMS
VENTILATION MECHANICAL EXHAUST
INCINERATOR - RESIDENCE
INCINERATOR - COMMERCIAL
X
525.00
X
515.00
X
$12.00
X
512.00
X
$19.00
X
$22.00
METHOD OF PAYMENT:
0 CASH CI CHECK 0 VISA 0 MC
CARD #:
AUTHORIZED SIGNATURE:
DATE:
EXPIRES:
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
535.00