2005, 03-14 Permit App: 05000745 ROW, Plumbing ReversalPLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address:
Owner:
Mailing Address:
Contractor:
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
City
License #:
State Zip Code
Phone #:
City
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, ONSITE BUILT
X
$6.00
=
5
•
SINKS
LAVS/BASINS, 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
$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
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 DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
. $35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
leY
1 'a1
Project Address:
Owner:
Mailing Address:
Contractor:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
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Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):
Mailing Address:
`3ai ft
License #:
City
State Zip Code
Phone #: Z 3 /- &o'
ce
- State Zic Code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$1'2.00
=
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
1
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
8
BOILERJREFRIGERAT1ON
101 - 500M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
F 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
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
$1.00
=
18
DUCT SYSTEMS
•
X
$10.00
=
19
VENTILATING FANS
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less 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 1 HOOD
X
$50.00
=
24
TYPE II HOOD
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 STOVEJINSERT
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:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Silolane
,0•0Valley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
•
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit #
ROW CONSTRUCTION PERMIT
Location of property 1//g)
Address Parcel #, if available)
Applicant Name /04l, Y( Fax
Fax
Address
Contractor's Name c/4vA& kt5
Address D2% n) 1, l % nJ
Phone
Phone 2 57-g 0,5-g
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ▪ Driveway
n Curb & Gutter • Gas Installation/Repair
n Cable/Conduit/Pole ▪ Sidewalk Repair/Construction
I I Water Installation/Repair Other
nPavement Cut
Dimensions
Bond/insurance certification must be on file with the City. Bond #
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder
Signature
" Fees Paid$
(Application) (Inspection)
Date
Init
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)
Permit not valid until One -Call Notification Ticket # entered here
Date
PERMIT MUST BE KEPT ON SITE
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.
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