2005, 03-24 Permit App: 05000898 Sewer, Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX:, (509).688-0037
For Inspections, Call (509) 688-0054
Project Address: 3 cl f
Owner: u,4Lk *r a' -et--"
Mailing Add ess:
Contractor:7 -
Mailing Address:
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
1-{f
Phone (Daytime Contact):
3 L( '/ ..pe7 99cP-rd--
City State Zip Code
Licen #: 1,7( cL7//' Phone #:
(Ai /42 -
State
Zip Code
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/BAS!NS, 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
$6 00
=
8
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
X
$6 00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, A TION, REPAIR,
R L ,
t
X
$6 00
=
- LTD
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
$6.00
-
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56 00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
1/ 1. /fO
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
4",
swam
Val1ey
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF. PUBLIC 047-j
4, WORKS
Anticipated start date � � �,
Permit # J 0 �
ROW CONSTRUCTION PERMIT
Location of property 3 /
Address/ arcel #, if available)
Applicant Name Fax
Address ,p (1i5i'i1'
Contractor's Name Z- -���
Address Po. e o. /3Dc//
Contractor's Reg.# Z 66 06'- 1X7n/ci
Phone
Th.' 07un
Phone 29/-97e/
/ e
Expires &//0 C 7
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ewer Connection C Driveway
❑ Curb & Gutter
❑ Cable/Conduit/Pole
n Water Installation/Repair
❑ Pavement Cut
111
Gas Installation/Repair
❑ Sidewalk Repair/Construction
LI Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #,
SPECIAL CONDITIONS:
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder Si
nature
Fees Paid$
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed) Date
Permit not valid until One -Call Notification Ticket # entered here 5-0 76 4133
PERMIT MUST BE KEPT ON SITE
Date !nit
Excerpts from Spokane Valley Standards (3.24, and details A8 and A -8a):
• Every driveway approach must provide access to an off road parking area located
on private property. The driveway shall be of sufficient length so a vehicle in the
driveway does not project into the road right of way, sidewalk, or pathway.
• Public or private driveways in industrial, commercial, multiple family, church or
any like use shall be constructed to allow vehicles to exit without backing onto a
public road.
• Driveway approaches shall be constructed to avoid interference with existing
drainage inlets, culverts, road Lighting standards, utility poles, traffic regulating
devices, fire hydrants or other public utilities. The applicant shall bear the cost of
relocating any such public facility.
• Driveway approach grades within the right of way shall not exceed 8% in urban
area, or 2% in rural areas. Driveway grades shall not exceed 10% within ten feet of
a city right of way.
See Standards for a more complete listing of requirements.