2003, 05-02 Permit: BD03-214 Plumbing ReversalCity of
SPOKANE VALLEY
PLUMBING /MECHANICAL
PERMIT APPLICATION &
PERMIT # al9
Co`n�trac[oZ l rmation
/01-Cii tip
Job ALrep 4� �j
Contractor's Names
3c//Li S. G 6
Contractor's address
City9 1 l : T9i
Contractor Phone Number
99637
Zip Code
Appli a t Informatio
f'x-tm (' j'1'I 4
Owner Name `_ 0 r mut JC -I eu
°Osrpa,fit5 -2 c)3
city 9 a ti Zip Cole
Owner phone number �S
Tax Parcel Number (Assessors Number)
Contractor's registration card (or copy) must be presented at
time of submittal.
20l
9q7P\
Fixture Count /Schedule of Work
Mechanical Basic fee
Number Furnace (up to 100,000 btu )
Cas Ilot Water Heater
Cook Top & other appliances
Clothes dryer
Conversion burner
Gas logs, gas fireplace insert
Wood stove system
Appliance rent 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) $ 5. up to 4 outlets
($ 1. for every outlet after 4)
Total
Total
Fee Cost $ 14 k•(9C)
535.
$15. ea
$10. ca
$10. ea
$10. ea
$10. 3I
$10. ea
$25.
$ 7.50 ea
$ 10. ea
$12.
$12. ea
$10. ea
$12. ea
$12. ea
$8. ea
$12.
Plumbing
Number S4
Fee Cost $
Basic fee
Toilets Urinals
Tub & faucets
Shower heads
Bathroom sinks
Kitchen sinks
Dishwashers
$35.
$ 6. ea
$ 6. ca
$6. ea
$ 6. ea
$ 6. ea
$ 6. ea
Dit
Hot water tank $10. ca
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-ca-
liose Bib $ 6. ea
Total $
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
/d/. 1 i4 / //
Signature/ applican'
Date
HOMEOWNER INSTALLER ONLY
I hereby certify That I am the owner of the property described in this application. 1 understand that
the work is subject to inspection and approval by the City of Spokane Valley, and that / may not allow any
otter 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
Supplemental to Permit Number: Date Permit Issued
Permit Number Fee collected $
Issued By:
s-vme-pl
Date
Both