2006, 04-19 Permit App: 06001410 Cross ConnectionPermit Center
Spokane 11707 E Sprague Ave, Suite 106
cm c
.. Valley
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
Community Development www.spokanevallev.oro
Plumbing Permit Application
II
Commercial
�u10
PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS: ( 7/6
Building Owner
Name: 5--, Fr- puid: e
Phone: tb I S ..L K 7 i
Fax:
-'1 �
Address: i / /la 1 g f / ; Cr
J�,
City :WE4 ,v 1./4/ ,
State: 1,-)fr
Zip: ,1C,7,0(.,
Contractor
Name:
f �1 /¢ L %✓Y� f LAi'iifei0•i✓c�
Phone:
6 7 7` i) 2
Fax:
Address: isv 7l. /
City: pa) /- bo/t it j
State: tr
Zip: b 38
I
License No: J
City Business Lic:
Contact':,
Name:
D"tz- TN4C4-
Phone: j 9 ?5 S' %'$ /C
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
2
URINALS
$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
$6.00
7
CLOTHES WASHER
X
56.00
GARBAGE DISPOSAL
X
$6.00
9
WATER SOFTENER
X
56.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
12
ROOF DRAINS /OVERFLOW DRAINS
X
$6.00
13
FOUNTAINS, DRINKING
WATER PIPING/DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
X
$6.00
14
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$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
$6.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
21
PRIVATE SEWAGE DISPOSALJSYS
$20.00
22
INDUSTRIAL WASTE INTERCEPTOR
X
$15.00
METHOD OF PAYMENT:
CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
Permit Center
Spokane 11707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
Community Development www.spokanevallev.or2
Mechanical Permit Application (l Commercial
.000Va11ey
PERMIT NUMBER:
PERMIT FEE:
Residential
SITE ADDRESS:
Building Owner
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
Contractor
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact
Name:
Phone:
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
$100.00
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
6
7
USED APPLIANCE (WSEC min. AFUE rating)
BOILER/REFRIGERATION
More than 400,000
x
$100.00
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
15
FUEL BURNING WATER HEATER
X
$10.00
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
17
GAS PIPING (each outlet)
X
$1.00
18
DUCT SYSTEMS
X
$10.00
19
VENTILATING FANS
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
EVAPORATIVE COOLERS
X
$10.00
23
TYPE I HOOD
x
$50.00
24
TYPE II 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
$25.00
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:
DCASH ❑ CHECK ❑ VISA ❑ MC
CARD #:
AUTHORIZED SIGNATURE:
REVISED 8/26/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE: