2005, 06-20 Permit Application: 05002090 Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688 -003
For Inspections, Call (509) 688-0054
/ %
Project Add ess • f l/ 0' --) �7 Permit Use:
`Y/7 s.e2tfil
Mailing Address:
Owner
Contractor:
Mailing Address: �� /�l c>
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spoka[te Valley, WA 99206
—900
Phone (Daytime Contact): A
City State Zip Code
License #: 777 / lef Phone #:
Al /7 /144 �. 7
Zip Code
City
' State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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
$6.00
=
7
CLOTHES WASHER
X
$5.00
=
8
GARBAGE DISPOSAL
X
$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
=
12
ROOF DRAINS /OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
-,
14
WATER PIPING /DRA OAS 1E,
VENT, PLUMBIN E RSA .
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
/
X
X
$6.00
$6.00
=
=
CCC
(f 1 i)
15
SEWAGE EJECTOR ����
GRINDER, SUMP PUMP
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
X
$6.00
$6.00
=
=
20
MISCELLANEOUS PLUMBING
FIXTURE
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X $15.00
=
�LJ
METHOD OF PAYMENT:
,.�
c;ASH ❑ CHECK
DATE:
SUBTOTAL
❑ VISA ❑ MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
q/ /1)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Spokane
Project Address:
Owner:
Mailing Address:
Contractor:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688 -0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
Mailing Address:
License #:
City
State
Phone #:
Zip Code
Cit
State
Zip Code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
=
6
USED APPLIANCE 'SEC min. AFUE ratin•
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
$10.00
=
FUEL BURNING WATER HEATER
X
$10.00
=
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
GAS PIPING each outlet
X
$1.00
=
18
DUCT SYSTEMS
X
$10.00
=
^,9
VENTILATING FANS
I X
;10.00
=
20
AIR HANDLER DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE 11 HOOD
X
$10.00
=
25
HEAT PUMP /AIR CONDITIONER
0 -3 TON
X
$12.00
=
26
AIR CONDITIONER
3 -15 TON
X
$20.00
=
27
AIR CONDITIONER
15 -30 TON
X
$25.01)
=
28
AIR CONDITIONER
30 -50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
33
REPAIR & ADDITIONS
X
$15.00
=
34
VENTILATION SYSTEMS
X
$12.00
=
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
=
36
INCINERATOR - RESIDENCE
X
$19.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE: