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2006, 05-01 Permit App: 06001620 Residence-RefundedProject Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/1/2006 Page 1 of 2 Project Information: Permit Use: SFR, GAS HEAT ON SEWER Ate. Contact: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 C - S - Z: SPOKANE, WA 99223 Setbacks: Front Left: Right: Rear: Phone: (509) 568-1013 Group Name: Site Information: Project Name: ARVle Plat Key: Name: WOODLAND TERRACE ADD ZWIPNIONSWINONSEINKAMISINFIAMMININ District: Sout Parcel Number: 35233.1616 Block: SiteAddress: 1416 S CHRONICLE RD Location:: CSV Zoning: UR -3.5 Water District: Area: 8,875 Sq Ft Urban Residential 3.5 Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: „„ Review Building Plan Review Lot: Owner: Name: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 SPOKANE, WA 99223 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Driveway/Approach Released By Originally Released: Landuse/Zoning/HE Conditions 5/1/2006 By: amblake Released By: Sewer Review Originally Released: 4/27/2006 By: HMStinson Released By: Permits: Operator: AMB Printed By: AMB Print Date: 5/1/2006 Project Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/1/2006 Page 2 of 2 Approach Contractor: LINDSEY CONSTRUCTION INC Firm: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 Phone: (509) 879-3420 SPOKANE, WA 99223 Building Permit Contractor: LINDSEY CONSTRUCTION INC Firm: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 Phone: (509) 879-3420 SPOKANE, WA 99223 Mechanical Permit Contractor: ROCK CREEK HTG AIR & Firm: ROCK CREEK HTG AIR & REFRI Address: PO BOX 1032 Phone: (509) 230-7389 RATHDRUM ID 83858 Plumbing Permit Contractor: LINDSEY CONSTRUCTION INC Firm: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 Phone: (509) 879-3420 SPOKANE, WA 99223 Notes: yaiv4N<Sr44G'dd?iStditi4H1111C It% 12Z4S#YC'A1Rid A .ae r nine G me, ati i :� rs a inw ie .d a v Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill CONTROL AREA FOR DRAINAGE MORITORIUM SEE MAPS FOR SPECIFICS **DO NOT ISSUE BUILDING PERMITS FOR LTS 11 & 12 BLK 16, LTS 9-16 BLK 15, LTS 1 & 2 BLK 27 & LTS 1-8 BLK 28 UNTIL CC&R'S ARE ACCEPTED, SURETY IN PLACE FOR ALL IMPROVEMENTS OR FINAL CONST ACCEPT CERT& ANY DEDICATIONS OR EASEMENTS ARE RECORDED PER S RASKELL Payment Summary:-:',;,R.nxm x:sru+wxWnroKPau:-xATY-N1xswte.tfawn.crr•4 . cscx- sNEM0'..S,2er nys:.IV. ..4:,sura w Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: AMB Printed By: AMB Print Date: 5/1/2006 Project Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 05/04/2006 Page 1 of 3 Project Information: , • • Permit Use: SFR, GAS HEAT ON SEWER Contact: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 C - S - Z: SPOKANE, WA 99223 Setbacks: Front Left: Right: Rear: Phone: (509) 568-1013 Group Name: Project Name: Site Information: ONXIMYPOOVIDOIN.M100,413,.' 4.33e4riiigt91.3;ta.k4 1,M:9 - 4.00.1$6,4,14141*4d*.oti,Wirittli... 44E1,1416,41WI',4,4S 5105.0Pki,W.';.VVIWeiti Plat Key: Name: WOODLAND TERRACE ADD District: Sout Parcel Number: 35233.1616 Block: Lot: SiteAddress: 1416 S CHRONICLE RD Location:: CSV Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: 8,875 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Owner: Name: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 SPOKANE, WA 99223 Hold: Lil Depth: 0 Right Of Way (ft): 0 Review Information: ,,,,-.4,-,,,,,.','wt.FYIPailMIMIIWO9TeKV/71,V4IIPt FSiSZVS7P.KSIAP,W911151110S11.11 Review Building Plan Review Released 13y: Originally Released: 05/03/2006 By: TMELBOU Driveway/Approach Released By: Originally Released: 05/01/2006 By: amblake Landuse/Zoning/HE Conditions Released By: Sewer Review Permits: Originally Released: 04/27/2006 By: HMStinso 4110b Released By: 0(0103 Operator: AMB Printed By: AMB Print Date: 05/04/2006 Project Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 05/04/2006 Page 2 of 3 Contractor: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 SPOKANE, WA 99223 Item Description APPROACH -CONST IN ROW Contractor: Address: Approach Firm: LINDSEY CONSTRUCTION INC Phone: (509) 879-3420 Units Unit Desc LINDSEY CONSTRUCTION INC PO BOX 30792 SPOKANE, WA 99223 Description Grp Type 1&2 FAMILY R-3 VB 2ND FLOOR R-3 VB DECK OPEN R-3 VB GAR WOOD U-1 VB Item Description RESIDENTIAL PERMIT FEE WSBC SURCHARGE SF PLNS RVW < 7999 SQ FT Notes Contractor: ROCK CREEK HTG AIR & Address: PO BOX 1032 RATHDRUM ID 83858 Item Description DUCT SYSTEMS GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING HEAT PUMP OR A/C 0-3 TONS VENTILATING FANS GAS LOG OR GAS INSERT HOOD -TYPE II Fee Amount 1 NUMBER OF $50.00 Permit Total Fees: Building Permit $50.00 Firm: LINDSEY CONSTRUCTION INC Phone: (509) 879-3420 This Application: Total Project: Su Ft Valuation Su Ft Valuation 1,444 $124,718.28 1,444 $124,718.28 264 $19,715.52 264 $19,715.52 80 $1,200.00 80 $1,200.00 748 $14,212.00 748 $14,212.00 Totals: 2,536 $159,845.80 2,536 $159,845.80 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Fee Amount $1,329.75 $4.50 $531.90 Permit Total Fees: $1,866.15 Mechanical Permit Firm: ROCK CREEK HTG AIR & REFRI Phone: (509) 230-7389 Units Unit Desc 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 3 # OF UNITS 1 NUMBER OF 3 NUMBER OF 1 NUMBER OF 1 NUMBER OF Operator: AMB Printed By: AMB Permit Total Fees: Fee Amount $10.00 $10.00 $12.00 $3.00 $12.00 $30.00 $10.00 $10.00 $97.00 Print Date: 05/04/2006 Project Number: 06001620 Inv: 1 Application Date: 05/04/2006 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 SPOKANE, WA 99223 Item Description TOILETSBIDETS SINKS SHOWERS TUBS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER WATER PIPING - DWV Plumbing Permit Firm: LINDSEY CONSTRUCTION INC Units 2 4 1 2 1 1 1 4 Phone: (509) 879-3420 Unit Desc Fee Amount NUMBER OF $12.00 NUMBER OF $24.00 NUMBER OF $6.00 NUMBER OF $12.00 NUMBER OF $6.00 NUMBER OF $6.00 NUMBER OF $6.00 NUMBER OF $24.00 Permit Total Fees: $96.00 Notes: 7 .111.,ISZIAVMVIL• �La. :.15 Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill CONTROL AREA FOR DRAINAGE MORITORIUM SEE MAPS FOR SPECIFICS **DO NOT ISSUE BUILDING PERMITS FOR LTS 11 & 12 BLK 16, LTS 9-16 BLK 15, LTS 1 & 2 BLK 27 & LTS 1-8 BLK 28 UNTIL CC&R'S ARE ACCEPTED, SURETY IN PLACE FOR ALL IMPROVEMENTS OR FINAL CONST ACCEPT CERT& ANY DEDICATIONS OR EASEMENTS ARE RECORDED PER S RASKELL Payment Summary: Permit Type Approach Building Permit Mechanical Permit Plumbing Permit Fee Amount $50.00 $1,866.15 $97.00 $96.00 Page 3 of 3 u,��uaskaas:��ae^;rxa. remix.�;�rra��r-,:aram�.vxr-e�.�a�r Invoice Amount $50.00 $1,866.15 $97.00 $96.00 Amount Paid $0.00 $0.00 $0.00 $0.00 Amount Owing $50.00 $1,866.15 $97.00 $96.00 $2,109.15 $2,109.15 $0.00 $2,109.15 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: AMB Printed By: AMB Print Date: 05/04/2006 Project Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/25/2006 Page 1 of 3 Project Information: Permit Use: SFR, GAS HEAT ON SEWER Contact: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 C - S - Z: SPOKANE, WA 99223 Setbacks: Front Left: Right: Rear: Phone: (509) 568-1013 Group Name: Site Information: Project Name: Plat Key: Name: WOODLAND TERRACE ADD District: Sout Parcel Number: 35233.1616 Block: SiteAddress: 1416 S CHRONICLE RD Location:: CSV Zoning: UR -3.5 Water District: Urban Residential 3.5 Area: 8,875 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Lot: Owner: Name: LINDSEY CONSTRUCTION, INC Address: PO BOX 30792 SPOKANE, WA 99223 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Building Plan Review Released By: TiK 4. / O Originally Released: Driveway/Approach 5/3/2006 By: TMELBOU Released By: Originally Released: 5/1/2006 By: amblake Landuse/Zoning/HE Conditions Released By: Sewer Review Originally Released: 4/27/2006 By: HMStinson Released By: PER SEWER PERMIT P0603728 Originally Released: 5/8/2006 By: mturbak Operator: AMB Printed By: AMB Print Date: 5/25/2006 Project Number: 06001620 Inv: 1 Permits: Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/25/2006 Page 2 of 3 Contractor: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 SPOKANE, WA 99223 Item Description APPROACH -CONST IN ROW Approach Firm: LINDSEY CONSTRUCTION INC Phone: (509) 879-3420 Units Unit Desc Contractor: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 SPOKANE, WA 99223 Description Grp Type Notes 1&2 FAMILY R-3 VB 2ND FLOOR R-3 VB DECK OPEN R-3 VB GAR WOOD U-1 VB Item Description RESIDENTIAL PERMIT FEE WSBC SURCHARGE SF PLNS RVW < 7999 SQ FT Contractor: ROCK CREEK HTG AIR & Address: PO BOX 1032 RATHDRUM ID 83858 Item Description DUCT SYSTEMS GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING HEAT PUMP OR A/C 0-3 TONS VENTILATING FANS GAS LOG OR GAS INSERT HOOD -TYPE II Fee Amount 1 NUMBER OF $50.00 Permit Total Fees: Building Permit $50.00 Firm: LINDSEY CONSTRUCTION INC Phone: (509) 879-3420 This Application: Total Project: Su Ft Valuation SQ Ft Valuation 1,444 $124,718.28 1,444 $124,718.28 264 $19,715.52 264 $19,715.52 80 $1,200.00 80 $1,200.00 748 $14,212.00 748 $14,212.00 Totals: 2,536 $159,845.80 2,536 $159,845.80 Units Unit Desc Fee Amount 1 SELECT $1,329.75 1 SELECT $4.50 1 SELECT $531.90 Permit Total Fees: Mechanical Permit $1,866.15 Firm: ROCK CREEK HTG AIR & REFRI Phone: (509) 230-7389 Units Unit Desc 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 3 # OF UNITS 1 NUMBER OF 3 NUMBER OF 1 NUMBER OF 1 NUMBER OF Operator: AMB Printed By: AMB Permit Total Fees: Fee Amount $10.00 $10.00 $12.00 $3.00 $12.00 $30.00 $10.00 $10.00 $97.00 Print Date: 5/25/2006 Project Number: 06001620 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/25/2006 Contractor: LINDSEY CONSTRUCTION INC Address: PO BOX 30792 SPOKANE, WA 99223 Item Description TOILETSBIDETS SINKS SHOWERS TUBS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER WATER PIPING - DWV Plumbing Permit Firm: LINDSEY CONSTRUCTION INC Phone: (509) 879-3420 EIll b 330 A -A Units 2 4 1 2 1 1 1 4 Unit Desc Fee Amount NUMBER OF $12.00 NUMBER OF $24.00 NUMBER OF $6.00 NUMBER OF $12.00 NUMBER OF $6.00 NUMBER OF $6.00 NUMBER OF $6.00 NUMBER OF $24.00 Permit Total Fees: $96.00 Notes: Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill CONTROL AREA FOR DRAINAGE MORITORIUM SEE MAPS FOR SPECIFICS Lots on the north side of 14th in the 4800 and 4900 block have fill. Soils investigation/foundation engineering done by Strata (see plat file) requires: (1) footings = min. 24 inches wide (2) foundations no closer than 12 ft from north edge of fill **DO NOT ISSUE BUILDING PERMITS FOR LTS 11 & 12 BLK 16, LTS 9-16 BLK 15, LTS 1 & 2 BLK 27 & LTS 1-8 BLK 28 UNTIL CC&R'S ARE ACCEPTED, SURETY IN PLACE FOR ALL IMPROVEMENTS OR FINAL CONST ACCEPT CERT& ANY DEDICATIONS OR EASEMENTS ARE RECORDED PER S RASKELL Payment Summary:,,. Permit Type Fee Amount Invoice Amount Approach $50.00 $50.00 Building Permit $1,866.15 $1,866.15 Mechanical Permit $97.00 $97.00 Plumbing Permit $96.00 $96.00 Amount Paid $50.00 $1,866.15 $97.00 $96.00 Page 3 of 3 Amount Owing $0.00 $0.00 $0.00 $0.00 $2,109.15 $2,109.15 $2,109.15 $0.00 AJ,Lo /4,?( Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: AMB Printed By: AMB Print Date: 5/25/2006 Q Permit Center S okane 11707 E Sprague Ave, Suite 106 . \Talle Spokane Valley, WA 99206 Y (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevallev.ore PERMIT NUMBER: /4.2 -AD PERMIT FEE: Residential Construction ® New Construction 1 1 Accessory Bldg Permit Application ❑ Addition/Remodel Deck ❑ Other: SITE ADDRESS /11l6 ar'niaC� ASSESSORS PARCEL NO:3Sz�3 • 1 CA' 512- (vts h-? eledL. ((o 4-vasa-Itd LEGAL DESCRIPTION: /-1(P,9 0,40la n d 7 fraC Building Owner: Name: idnisey Zo/ f//l' Ml7 Mc. — Address: PO /1D x . 292...- City: 57/%/1 k4ne ///�� State:Wtk Zip: 1ggz' ' Phone: % .24,1,13� Fax: Y-�d 0 Contact Person Name: (Ortq 51— n Phone: 5-12k—I0 /3 DT X79'?sZD Describe the scope of work in detail: Contractor: Name:41fi SP!'c sr in c Address: Pd 6, 50792 City: 5.Ne-d r%C State:0)A Zip.9G%2 Phone: 9,e—id 13 Fax: c f Y? __/4),3 Contractor n SG -t e 6 44 zdxp Date: 0 ^D6 City Business Lic. No: Cost of Project: $ / q **************The followinc MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: lb DIMENSIONS: l�•`I'7 # OF STORIES: / lz TOTAL HABITABLE SPACE: �T%�/ %off MAIN FLOOR TO FTG: / t [ SQ. imilZ 2Nu FLOOR SQ. FTG: 613199 UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE AREA: Z7 7O FINISHED BAS SQ. FTG: MENT GARAGE SQ. FTG:(l(/ �'`C770- DECK/COV. PATIO SQ. FTG: 30% SLOPES ON PROPERTY: # OF BEDROOMS: 3 CONSTRUCTION TYPE: -1-mmitz HEAT SOURCE: q4A SEWER OR SEPTIC? ,e e6r-- The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction 05 or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the- roperty owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Signature Method of Payment: 0 Cash Bankcard #: Authorized Signature: REVISED 825/2005 0 Check ❑ Mastercard Expires: Date 41 --2../ -1 0 VISA VIN#: Permit Center Spokane 11707 E Sprague Ave, Suite 106 .0jUalley Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 Community Development www.spokanevallev.ore.com Mechanical Permit Application ER3VIT ITu1VIB} PET o Commercial o Residential SITE ADDRESS /e7/0 Building owner: Name: /li if?1. I60---%p� Phone: ��vt,--1D 1.- j 3 Fax 7 4/ 3 ^f d / Address: )-7 73 d7' Z City Adiestiat State _ Zip Contractor=.''-' - .., _ = - _. -- _ --- � - = _ --_- Name: r /_, &W� 1/ 14...1 Phone: Fax: Address: City State Zip License No: j 1 K CG( ' SdCity Business License No: 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 X $100.00 = 5 USED APPLIANCE (WSEC min. AFUE rating) Equal to or less than 400,000 X $50.00 = 6 USED APPLIANCE (WSEC min. AFUE rating) 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 = 15 FUEL BURNING WATER HEATER 1 X $10.00 = 16 MISC. FUEL BURNING APPLIANCE X $10.00 = 17 GAS PIPING (each outlet) 3 X $1.00 = 18 DUCT SYSTEMS 1 X $10.00 = 19 VENTILATING FANS 3 X $10.00 = 20 AIR HANDLER (DOES NOT include ducting) Equal to or Tess 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 II HOOD j 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: ❑CASH 0 CHECK 0 VISA 0 MC CARD #: SUBTOTAL DATE: PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05 Spokane ems' . Valley Community Development Permit Center 11707 E Sprague Ave, Suite 106 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.spokanevalley.ore.com Plumbing Permit Application PERMIT NUMBER: PERMIT FEE: ❑ Commercial ® Residential SITE ADDRESS /N Building owner 1,144.414% ei'yyJ�� 4.4.41,,____,Name: DESCRIPTION OF WORK # OF UNITS X Phone: v - mi, 3 Fax q Y 3 -16 %� Address: tin ?1 7 / Z 2 City State /y Zip 7 40 Contractor 2 URINALS Name: C'n D p z a4Ajt Phone: Fax: 3 TUBS Address: J X City State Zip License No: Q e.. -4D P1 -P 1 iti0 g 3 BATH, STALL, ON-SITE BUILT City Business License No: X $6.00 Contact 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 4 Name: $6.00 Phone: 6 DISHWASHER AUTHORIZED SIGNATURE: REVISED 8/26/05 DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 TOILETS WATER CLOSET, BIDETS 2 X $6.00 = 2 URINALS X $6.00 = 3 TUBS 2> X $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT 1 X $6.00 = 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 4 X $6.00 = 6 DISHWASHER / X $6.00 = 7 CLOTHES WASHER / X $6.00 = 8 GARBAGE DISPOSAL I 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/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL 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 41 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 DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: ❑ CASH 0 CHECK 0 VISA 0 MASTERCARD Card# EXPIRES: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05