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2005, 09-12 Permit App: 05003335 Plumbing FixturesProject Number: 05003335 Inv: I Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: ` Date: 09/12/2005 Page 1 of 2 Permit Use: 1 TOILET, 1 SHOWER, 1 SINK AND 1 WATER PIPING Setbacks: Front Left: Right: • Rear: Site Information: Plat Key: 001180 Name: Contact: BELKNAP PLUMBING Address: 3414 S ADAMS C - S - Z: VERADALE, WA 99037 Phone: (509) 921-5913 Group Name: - Project Name: HELSTROMS SUB #2 OPP District: Parcel Number: 45152.1135 Block: SiteAddress: 13014 E CATALDO AVE Location:: CSV Zoning: AGSUB Water District: Lol: Owner: Name: OPEN BIBLE CHURCH Address: 13014 E CATALDO AVE SPOKANE VALLEY, WA 99212 Hold: O Area: .,475.00 Acres Width: 85 Depth: 135 Right Of Way (ft): 50 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: , Review Plan Review Released 13y: Permits: Plumbing Permit Contractor: BELKNAP PLUMBING Firm: BELKNAP PLUMBING Address: 3414 S ADAMS RD Phone: (509) 921-5913 • VERADALE, WA 99037 Item Description Units Unit Desc Fee Amount TOILETS/BIDETS 1 NUMBER OF $6.00 SINKS 1 NUMBER OF $6.00 SHOWERS 1 NUMBER OF $6.00 WATER PIPING - DWV 1 NUMBER OF $6.00 PROCESSING FEE 1 SELECT $35.00 Permit Total Fees: $59.00 Operator: CJJ Printed By: KJK Print Date: 09/12/2005 Project Number: 05003335 Inv: I Application THIS IS NOT A PERMIT Penalties will be assessed for co%nmei;wcing work without a permit Notes: Date: 09/12/2005 Page 2 of 2 Payment Summary Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Plumbing Permit $59.00 $59.00 $59.00 $0.00 $59.00 $59.00 $59.00 $0.00 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: CJJ Printed By: KJK Print Date: 09/12/2005