2003, 04-16 Permit App: 00003106 Furnace, Water HeaterCity of
SPOKANE VALLEY
PLUMBING /MECHANICAL
PERMIT APPLICATION &
PERMIT # iOic7
Contractor Information
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Job Ad ss
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Contra tor's anies
Contractor ss address
Ci Zip Code
Contractor Phone Number
Appikant or tion
Owner Name
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Own Addrfers 9 go
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Owner phone number
Tax Parcel Number (Assessors Number)
Contractor's registration card (or copy) must be presented at
time of submittal.
Fixture Count/Schedule of Work
Mechanical Basic fee
Number Furnace (up to 100,000 btu )
Gas Hot Water Heater
Cook Top & other appliances
Clothes dryer
Conversion burner
Gas logs, gas fireplace insert
Wood stove system
Appliance vent repair - relocation
Laundry Washer / sink
A/C unit ((up to 3 tons )
Unit Heater (up to 100,000 btu )
Fireplace insert (wood - pellets )
Evaporative coolers
Commercial Hood
Exhaust vents
Ducts system
Gas Piping ( outlets )
($ 1. for every outlet after 4)
Total
Total
Fee Cost $
$35.
$15. ea
$10. ea
$10. ea
$10. ea
$10.
$10. ea
$25.
$ 7.50 ea
$ 10. ea
$12.
$12. ea
$10. ea
$12. ea
$12. ea
$8. ea
$12.
$ 5. up to 4 outlets
Plumbing)
Number _-
Fee Cost $
Basic fee $35.
Toilets Urinals $ 6. ea
Tub & faucets $ 6. ea
Shower heads $ 6. ea
Bathroom sinks $ 6. ea
Kitchen sinks $ 6. ea
Dishwashers $ 6. ea
Hot water tank $10. ea
Lawn sprinkling system $25.
Private sewage system $20.
Vacuum type breaker (5) $25.
Drinking fountains $ 6. ea
Floor Drains $ 6. ea
Sump $ 6. ea
Backflow preventor $ 6. ea
pipe -drainage repair $ 6. ea
Hose Bib $ 6. ea
Total $ � 7, d d
1 hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card :
Visa Mastercard No. _ _ _ Expiration date
Print name of holder Signature
Signature of applicant
Date
HOMEOWNER INSTALLER ONLY
I hereby certify that I am the owner of the property described in this application. I understand that
the work is subject to inspection and approval by the City of Spokane Valley, and that I may not allow any
other person, including a licensed contractor, to do any work under this permit.
Signature of owner
Date
FOR OFFICE USE ONLY
Date received
Circle one:
Plumbing Mechanical
Both
Supplemental to Permit Number: Date Permit Issued �
Permit Number Fee collected $ 11 710'
Issued By: )3�
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Date 4 ��lv's3