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2007, 04-23 Permit App: 07001407 ResidenceProject Number: 07001407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/23/2007 Page 1 of 3 Project Information: Permit Use: SFR W/ATT GAR Setbacks: Front 19 Left: 5 Right: 5 Rear: UN Site Information: Plat Key: Name: Range Contact: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 205 C - S - Z: SPOKANE VALLEY, WA 99216 Phone: (509) 624-4598 Group Name: Project Name: WFMNOMMINWIWEWAN., District: East Parcel Number: 55073.2608 SiteAddress: 17206 E NORA AVE Location:: CSV Block: Lot: Owner: Name: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 205 SPOKANE VALLEY, WA 99216 Zoning: UR -3.5 Urban Residential 3.5 Water District: 134 CONSOLIDATED ID #19 Area: 6,500 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Building Plan Review Released By: Driveway/Approach Released By: Landuse/Zoning/HE Conditions Sewer Review Permits: Released By: Operator: JD Printed By: JD Print Date: 4/23/2007 Project Number: 07001407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/23/2007 Page 2 of 3 Approach Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Item Description APPROACH -CONST IN ROW Units Unit Desc Fee Amount 1 NUMBER OF $50.00 Permit Total Fees: $50.00 Building Permit Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Building Characteristics Building Height 19.3 This Application: Total Project: Description Grp Type Notes Sp Ft Valuation Su Ft Valuation 1&2 FAMILY R-3 VB oro- 1,538 $140,511.68 1,538 $140,511.68 GARAGE U-1 VB O14* 7.97 , $15,143.00 797 $15,143.00 R 3 v 3 Item Description RESIDENTIAL PERMIT FEE WSBC SURCHARGE SF PLNS RVW < 7999 SQ FT Totals: .25-335 $155,654.68 2,335 $155,654.68 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Fee Amount $1,307.35 $4.50 $522.94 Permit Total Fees: $1,834.79 Mechanical Permit Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Item Description DUCT SYSTEMS GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING AIR CONDITIONER:4-15 TONS VENTILATING FANS GAS LOG OR GAS INSERT HOOD -TYPE II Units Unit Desc 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 3 # OF UNITS 1 NUMBER OF 4 NUMBER OF 1 NUMBER OF 1 NUMBER OF Operator: JD Printed By: JD Fee Amount $10.00 $10.00 $12.00 $3.00 $20.00 $40.00 $10.00 $10.00 Permit Total Fees: $115.00 Print Date: 4/23/2007 Spokane ., . Valley° Community Development Residential Construction Permit Application Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.spokanevalle_y.org APR 18 New Construction ❑ Addition/Remodel ❑ Other: PERMIT NUMBER: 4 01 PERMIT FEE: Accessory Bldg Deck SITE ADDRESS: f' 7 Z-069 (. )o Z-/4 ASSESSORS PARCEL NO: LEGAL DESCRIPTION: /..-LT. I N(,�L-x"55 Pub Building Owner: Name: r`,tit_L_t Ui/,/ I!r,,k�� 1/VC. Address: / 6I. Lei (';-, /ni ui /3ii'r-i 4 i%i (ki TE 7.--O") Name: Phone:` (i (:) `-2 4I -4 S,/S Fax: -3 Uu( iC Zit -‘1 3 C? Contractor Lic No: ,Exp Date: juctlht0"/Z- t Address: IMPERVIOUS SURFACE /,S�U� >r FINISHED BASEMENT SQ. FTG: i3/a- City: State: Zip: Phone: Fax: HEAT SOURCE: 5 Contact Person Name: L: 1 u f 61,24105a Phone: 7 Y 7 Describe the scope of work in detail: Contractor: Name: r`,tit_L_t Ui/,/ I!r,,k�� 1/VC. Address: / 6I. Lei (';-, /ni ui /3ii'r-i 4 i%i (ki TE 7.--O") City: app ,w1:__ u n -LLL; ‘l State: JA Zip: (eft e1 Phone:` (i (:) `-2 4I -4 S,/S Fax: -3 Uu( iC Zit -‘1 3 C? Contractor Lic No: ,Exp Date: juctlht0"/Z- t City Business Lic. No: Cost of Project: $ Z/ S, wc) t l i 1/-1C. /U c&., ucrIc ) Proposed Use: `tet Aft...( -4_;" ):-/4-14/1/L.-s-1 **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: I°tr DIMENSIONS: SS�5E,' # OF STORIES: 1 TOTAL HABITABLE SPACE: Ij 3� MAIN FLOOR TO SQ. FTG:AREA: 1 L E, 5P 2"D FLOOR SQ. FTG: ki"1 UNFIN BASEMENT SQ. FTG: ira.4 IMPERVIOUS SURFACE /,S�U� >r FINISHED BASEMENT SQ. FTG: i3/a- GARAGE SQ. FTG: 7 Cl 1 DECK/COV. PATIO SQ. FTG: A 30% SLOPES ON PROPERTY: N `'-' # OF BEDROOMS: CONSTRUCTION TYPE: IUB, HEAT SOURCE: 5 SEWER OR SEPTIC? SL-0v/ The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of 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 property 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 0 Check Bankcard #: Authorized Signature: REVISED 2/15/07 DATE: 4 - j e - 7 ❑ Mastercard ❑ VISA Expires: VIN#: *Wane fiValley® 11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206 509.688.0036 ♦ Fax: 509.688.0037 ♦ cityhalt@spokanevalley.org Residential Plan Submittal Minimums ❑ Completed Building & Mechanical application with: Accurate address, Parcel Number and/or Legal Description, description of work, owner and contractor information, signature, and date. ❑ Two sets of plans including Site Plan, elevations, floor plans, foundation plans With details, roof plan, framing plans & details. ❑ Show the height of any proposed buildings or accessory structures. ❑ Floor plan for each floor: Dimension to scale (minimum 1/8") and label each Room (including sq. footage of house and garage on plans) Show each level of existing house and square footage of any additions. ❑ All braced wall panel types: show locations and details of installation, including engineered design. ❑ Egress windows: Provide at least one window or exterior door approved for Emergency escape or rescue from a basement and in every room for sleeping. ❑ Smoke detector locations ❑ 22" X 30" attic access location ❑ 18" X 24" crawl space access: ❑ One-hour separation detail: between house and garage ❑ Floor framing details: Joist type, size, spacing and installation details O Roof framing plan and details O Furnace and hot water heater location. ❑ All header locations: type, size, and connections O Foundation plan O Insulation information Project Number: 07001407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/23/2007 Page 1 of 3 Project Information: Permit Use: SFR W/ATT GAR Setbacks: Front 19 Left: 5 Right: 5 Rear: UN Site Information: MIPOOMEINSMINCOMIEZUM Plat Key: Name: Range Parcel Number: 55073.2608 SiteAddress: 17206 E NORA AVE Location:: CSV Contact: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 205 C - S - Z: SPOKANE VALLEY, WA 99216 Phone: (509) 624-4598 Group Name: Project Name: District: East Block: Lot: Owner: Name: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 205 SPOKANE VALLEY, WA 99216 Zoning: UR -3.5 Urban Residential 3.5 Water District: 134 CONSOLIDATED ID #19 Area: 6,500 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: __ sa .*.. erinUrditff Hold: ❑ Depth: 0 Right Of Way (ft): 0 CkfeblettaMIMOMMIIMMINNOVAI Review Building Plan Review Released By: Driveway/Approach Released By: Landuse/Zoning/HE Conditions Sewer Review Permits: Released By: Released By- Operator: y Operator: JD Printed By: JD Print Date: 4/23/2007 Project Number: 07001407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/23/2007 Page 2 of 3 Approach Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Item Description APPROACH -CONST IN ROW Units Unit Desc Fee Amount 1 NUMBER OF $50.00 Permit Total Fees: $50.00 Building Permit Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Building Characteristics Building Height 19.3 This Application: Total Project: Description Grp Type Notes i./ �l S Ft Valuation Sq Ft Valuation 1&2 FAMILY R-3 VB /' /f 38 $140,511.68 1j,5�8" $140,511.68 GARAGE U-1 VB 132- l' $15,143.00 7A7 $15,143.00 CEJ PAY4D 3 v Q Tota: 2,335 $155,654.68 2,335 $155,654.68 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,307.35 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW < 7999 SQ FT 1 SELECT $522.94 Permit Total Fees: Mechanical Permit $1,834.79 Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 Item Description DUCT SYSTEMS GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING AIR CONDITIONER:4-15 TONS VENTILATING FANS GAS LOG OR GAS INSERT HOOD -TYPE II Units Unit Desc 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 3 # OF UNITS 1 NUMBER OF 4 NUMBER OF 1 NUMBER OF 1 NUMBER OF Operator: JD Printed By: JD Fee Amount $10.00 $10.00 $12.00 $3.00 $20.00 $40.00 $10.00 $10.00 Permit Total Fees: $115.00 Print Date: 4/23/2007 Project Number: 07001407 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/23/2007 Contractor: SULLIVAN HOMES LLC Address: 16114 E INDIANA AVE STE 200 SPOKANE VALLEY, WA 99216 Item Description TOILETS/BIDETS SINKS SHOWERS TUBS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER FLOOR DRAINS MISCELLANEOUS FIXTURES Notes: Plumbing Permit Units 2 5 2 1 1 1 1 1 3 Page 3 of 3 Firm: SULLIVAN HOMES INC Phone: (509) 624-4598 Unit Desc NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF Permit Total Fees: Fee Amount $12.00 $30.00 $12.00 $6.00 $6.00 $6.00 $6.00 $6.00 $18.00 FLORA ESTATES -REFER TO ADE -19-06 FOR LOT WIDTH/FRONTAGE-MH FLORA ESTATES -SEE FILE ADE -19-06 FOR LOT FRINTAGE/WIDTH-MH Payment Summary: Permit Type Approach Building Permit Mechanical Permit Plumbing Permit Fee Amount $50.00 $1,834.79 $115.00 $102.00 Invoice Amount $50.00 $1,834.79 $115.00 $102.00 xak Amount Paid $0.00 $0.00 $0.00 $0.00 $102.00 Amount Owing $50.00 $1,834.79 $115.00 $102.00 $2,101.79 $2,101.79 $0.00 $2,101.79 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: JD Printed By: JD Print Date: 4/23/2007 tug 29 02 08: 482 Dan Cenis 509-755-67q_3 200I WSEC Residential Cg-mpli.ance Fran Prescriptive (Chapter 6) Options for all R Occupancies, Climate Zone 2 �> Heat source_ A7_L. p-1 rag 1NSTRULI10N5 1) Yorsperrnit wf71 be proemsed more efficientlyifyou provide all.of the requested infomnationDep�rtrcient g{af Lin help you with general Cia tions about this form Your building must matchthe selected option reran r cents wiEhout exceptions or stabstitutions_ . 2) Glazing percentage determines ines which option to choose. Complete the follovrrag glazing area dmlation before proceeding- to the option table below_ •- GLA2T1`TG AREA CALCULATION_ 1 V 1 SF. 1 S �7 SF. = TOTAL WINDOW AREA, _ - _--_.__ .__ __HPAT7D FLOOR ARE4 _ALL FLOORS)_7-791CF GI�9ZFIVG_ x.1.7 NOTE' Use luugh opaning (RIO) for window area. Include all half -lite and full -lite door gle tg iit this calculation.: CAN'T -COMPLY? If none of the Prescriptive (C'hapter ) Options below are acceptable! consider systems analysis (Chapter 4) or. Component Performance (Chapter 5) Approach_. The main adrrailtage is flerobility to juggle individual U- faidors (R values! as long as an overall ma)5rnum valae isn't ear —ded. Note that the overall p=i'onManm regni:rementg are ilo less stii agent than the PresuipEve requirements_ Caltnlaidons may be perfoinred by hand o4 using an acceptable coMpater software progaam. Helpful forays and other resonates can be downloaded at htto_//w itv_pstergl=.x t ednit bt it iutgs. . - CIRCLE OPTION • TABLE S-2 . PRES6RtPTJE'KEC7UIREME111T—S EOR GROUPR.A.CGUPAItCY CLIMATE 'ZDUE Merman. Ca -re • 0. Nomvrat 1L -valves arc fm -wood frame asscrnbtis-only or assemblies bank in accordance with Section 601.1_ 1. Pau numrcgvi*uarntsforeach'optionlisied_ Tor rsamplo,ifapropncad ddsigiLasagla-infraliafotltcccmditidnedfloor area of 13% it shell cdmplywith all ofta-requirt -nts ofthc,IS% glthng option (orbiglae). Proposed•de9gns which m=ot meet the Specific r'erpar> tents ofn Ii_wed option above map calculate crue 1 am c by Chapters 4 or 5 of this Code. • 2 Acquir,mcntapplir-to all ceiliacarpteing1Frafterrrjoistvavliu3ea-Bugs_ Adv thccates Advanecd. Thorned 3. Rcgir to applicable only to single rafter orjoutvaolted catlings: '— azac wall-- all la `l. cit -- ' - -- -- alio _ .' 4.. Belovp-adewaus shall be insnlatc3 eifbeon merelatortn'c'minim�,.n levelof R-10, or on -tb_m ortotficsame tcr�1 di watlf.sbovc graded Lxrvior insolatisairata➢cd oa below gredd walls shallbe a wstni rests -cult material rvaanfacturd for its intcadeduse, andinstalked accoraivgto themanvfacrurct's speci6ctays: Sec Scctior_ Boal ' 5_ Floats ovcruawl spates or clptscd lo ambirarairconditions. • 6_ Required slab Perimeter insulatina shell be a natcrrr-qim*r 1material, msnufacrurcd for its intendcnuse, and tavern cd according to Maratacarier's spccincitions. Sys Seaton 6024: • .. '-. - . - - - • 7. Tut_ denotes standardirainmg 16 inebes on center with benders insulafrdwith a tmmuntua of -R-5 irsuladoru 8_ This Iran insularionicquircmcntdmotro R-19 wall cavitymsulntiern plus 2-= foam sheathing. 9_ Doors, iocluding all fire doors, stall be assigned dcuoltU-factors from Tabic 10-66C- 10. Where a maxrimura glaring arra is listed, ihr tut1gls3ng area . (combined :crtienlplus overhead) as a percent ofgrnss conoiuoncd.loor arca rl-+llbe leas tlina or cgoaltn that wine_ Overhead glaingwith U- factor ofU 0.40 or less is notiticlu dad In glan❑g atm Iimiratims_ - .11. Ovcrbcadglathng shall ams, fscroa druon.1oei is accordance .10b.1TRC 100 or es socci5 =5 mScdion50LIS_ 12. Log and solid umber walls with &minimum avcace thickness of 33- male r apt from chis iasalation icclnircmcat ATT(-ril7_R9 161 ttn1.inn 7GC Lr710 Tn . n e nT? a 5' 5-0" 30' DRIVEWAY .69°50'01"W. / 65.00' LOT 8 BLOCK 1 17206 E. NORA AVE 6,500 S.F. S.99°50'01"W. 11 65.00' This site plan is being submitted for the purpose of obtaining a building permit and is true and correct representation of the proposal. All known property lines/dimensions, curb lines, structures and easements have been identified. Also indicated are wetlands, bodies of water, steep slopes and other critical areas. Signed: Date: PLOT EIA\ 5CAl.1 1" - 20' 5' 5'-0" . Z 0 o� Address: 17206 Nora Ave ate: 5pocane Valleg, WA, 99016 Location: \ Job No: INVM55 5/ 10/ 07 Lai -8 131-OCK 436-8-I -INV-CLEFRNASP Plan: COMA Sheet Title PL O-' PLAN IM Valley MECHANICAL PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Cali (509) 688-0054 Project Address: 17206 E Nora Ave 99216 Owner: Sullivan Homes Mailing Address: 16114 E. Indiana Ave Spokane Valley WA 99216 Contractor: Sturm Heating and Plumbing Mailing Address: 1112 N Nelson 99202 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Permit Use: Phone (Daytime Contact): 509-624-4598 City License #: sturmi*210gf Spokane Cit State Zip Code Phone #: 325-4505 WA State Zip Code DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 1 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 1 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 4 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 I HOOD X $50.00 = 24 TYPE II HOOD 1 X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = 26 AIR CONDITIONER 3-15 TON 1 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: DATE: ❑CASH ❑ CHECK ElVISA 0 MC SUBTOTAL PROCESSING FEE $35.00 PLUMBING PERMIT APPLICATION IllIt 1101111e1‘111% Phone: (509) 688-0036; FAX: (509) 688-0037 Valley For Inspections, CaII (509) 688-0054 Project Address: 17206 E Nora Ave 99216 Owner: Sullivan Homes Mailing Address: 16114 E Indiana Ave City Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Permit Use: Residential Phone (Daytime Contact): 509-624-4598 State Zip Code Contractor: Sturm Heating & Plumbing License* STURMI*210QF Phone #: 325- 4505 1112 N. Nelson, Spokane WA 99202 Mailing Address: Zip Code City State BANKCARD NUMBER: AUTHORIZED SIGNATURE: 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 1 X $6.00 = 4 SHOWERS (PER TRAP) BATH, STALL, ON-SITE BUILT 2 X $6.00 = 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 5 X $6.00 = 6 DISHWASHER 1 X $6.00 = 7 CLOTHES WASHER 1 X $6.00 = 8 GARBAGE DISPOSAL 1 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 1 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 3 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 ❑ CHECK ❑ VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: