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: