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2006, 05-10 Permit App: 06001732 ResidenceProject Number: 06001732 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/10/2006 Page 1 of 3 Project Information: Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -GAS Setbacks: Front Site Information: Plat Key: Left: Right: Rear: Name: Range Contact: SULLIVAN HOMES Address: 16114 E INDIANA AVE SUITE 200 C - S - Z: SPOKANE VALLEY, WA 99216 Phone: (509) 624-4598 Group Name: Project Name: District: Parcel Number: 55073.2612 SiteAddress: 17215 E NORA AVE Location:: CSV Zoning: UR -3.5 Water District: Block: Urban Residential 3.5 Lot: Owner: Name: SULLIVAN HOMES Address: 16114 E INDIANA SPOKANE VALLEY, WA 99216 Hold: ❑ Area: .00 Acres Width: 0 Depth: 0 Right Of Way (ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Building Plan Review Driveway/Approach Originally Released: 5/10/2006 By: TMELBOU Originally Released: 5/10/2006 By: amblake Landuse/Zoning/HE Conditions Sewer Review Permits: Originally Released: 5/9/2006 By: HMStinson eleased Y: Operator: CJJ Printed By: AMB Print Date: 5/10/2006 Project Number: 06001732 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/10/2006 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 Units Unit Desc Fee Amount APPROACH -CONST IN ROW 1 NUMBER OF $50.00 Contractor: SULLIVAN HOMES LLC Address: 16114 E INDIANA AVE STE 200 SPOKANE VALLEY, WA 99216 Description Grp Type 1&2 FAMILY R-3 VB DECK OPEN R-3 VB GAR WOOD U-1 VB Item Description RESIDENTIAL PERMIT FEE WSBC SURCHARGE SF PLNS RVW < 7999 SQ FT Notes Contractor: STURM HEATING Address: 1112 N NELSON SPOKANE, WA 99202 Item Description DUCT SYSTEMS GAS APPLIANCE<=100,000BTU GAS PIPING VENTILATING FANS GAS LOG OR GAS INSERT HOOD -TYPE II GAS APPLIANCE - MISC. Permit Total Fees: $50.00 Building Permit Firm: SULLIVAN HOMES INC Phone: (509) 624-4598 This Application: Total Project: Sq Ft Valuation Sq Ft Valuation 1,606 $138,710.22 1,606 $138,710.22 90 $1,350.00 90 $1,350.00 606 $11,514.00 606 $11,514.00 Totals: 2,302 $151,574.22 2,302 $151,574.22 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Permit Total Fees: Mechanical Permit Units 1 1 3 3 1 1 1 Operator: CJJ Printed By: AMB Fee Amount $1,284.95 $4.50 $513.98 $1,803.43 Firm: STURM HEATING Phone: (509) 325-4505 Unit Desc NUMBER OF NUMBER OF # OF UNITS NUMBER OF NUMBER OF NUMBER OF NUMBER OF Permit Total Fees: Print Date: Fee Amount $10.00 $12.00 $3.00 $30.00 $10.00 $10.00 $10.00 $85.00 5/10/2006 Project Number: 06001732 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 5/10/2006 Page 3 of 3 Contractor: STURM HEATING Address: 1112 N NELSON SPOKANE, WA 99202 Item Description TOILETSBIDETS SINKS SHOWERS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER FLOOR DRAINS WATER PIPING - DWV Notes: Payment Summary: Permit Type Approach Building Permit Mechanical Permit Plumbing Permit Plumbing Permit Firm: STURM HEATING Phone: (509) 325-4505 Units Unit Desc 2 NUMBER OF 4 NUMBER OF 2 NUMBER OF 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF 3 NUMBER OF Fee Amount $50.00 $1,803.43 $85.00 $90.00 Permit Total Fees: Invoice Amount $50.00 $1,803.43 $ 85.00 $90.00 Fee Amount $12.00 $24.00 $12.00 $6.00 $6.00 $6.00 $6.00 $18.00 $90.00 Amount Paid $0.00 $0.00 $0.00 $0.00 Amount Owing $50.00 $1,803.43 $85.00 $90.00 $2,028.43 $2,028.43 $0.00 $2,028.43 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: AMB Print Date: 5/10/2006 Project Number: 06001 732 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 05/08/2006 Page 1 of 2 Project Information: Permit Use: NEW RESIDENCE W/ATTACHED GARAGE -GAS Setbacks: Front Site Information: Plat Key: Left: Right: Rear: Name: Range Contact: SULLIVAN HOMES Address: 16114 E INDIANA AVE SUITE 200 C - S - Z: SPOKANE VALLEY, WA 99216 Phone: (509) 624-4598 Group Name: Project Name: WLW District: Parcel Number: 55073.2612 Block: SiteAddress: 17215 E NORA AVE Location:: CSV Lot: Owner: Name: SULLIVAN HOMES Address: 16114 E INDIANA SPOKANE VALLEY, WA 99216 Zoning: UR -3.5 Urban Residential 3.5 Water District: Hold: ❑ Width: 0 Depth: 0 Right Of Way (ft): 0 Area: .00 Acres Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Building Plan Review ReleasedBy: Driveway/Approach Released By cif Landuse/Zoning/HE Conditions Sewer Review Released By: Permits:ralwA f' . mt,',§ . ear« ava:e-.. <.. a r., .r ._. : : :., w* .» , -,r,*, .. ; ,so,rf:-x, :ur a Operator: CJJ Printed By: CJJ Print Date: 05/08/2006 Project Number: 06001732 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 05/08/2006 Page 2 of 2 Approach Contractor: SULLIVAN HOMES LLC Firm: SULLIVAN HOMES INC Address: 16114 E INDIANA AVE STE 200 Phone: (509) 624-4598 SPOKANE VALLEY, WA 99216 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 Mechanical Permit Contractor: STURM HEATING Firm: STURM HEATING Address: 1112 N NELSON Phone: (509) 325-4505 SPOKANE, WA 99202 Contractor: STURM HEATING Address: 1112 N NELSON SPOKANE, WA 99202 Notes: Plumbing Permit Firm: STURM HEATING Phone: (509) 325-4505 Payment Summary: 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: CJJ Print Date: 05/08/2006 BUILDING PERMIT APPLICATION WORKSHEET Siokane���' �� ; 'gity;of Spokane Valley Community Development Department Building Division V11707 E. Sprague Avenue, Suite 106 Spokane Valley, ��P MAY 2006WA 99206 ,i ( phone: (509) 688-0036; Fax: (509) 688-0037 i! l j Street Address: 17215 E Nora Ave 99216 Assessor's Tax Parcel Number(s): Legal Description: Lot 3 Block 2 PERMIT DESCRIPTION: New Residential Construction ® Building Permit ❑ Relocation ❑ Change in Use ❑ Grading ❑ Tenant Improvement ❑ Fire Safety ❑ Other ❑ Manufactured Home Owner: Sullivan Homes Phone: 509-624-4598 Fax: Address: 16114 E. Indiana Ave City: Spokane Valley State: WA Zip: 99216 ❑ Contractor: Same Phone: Fax: Address: City: State: Zip: WA State Contractor License #: Sullihi042JT Applicant: Same Phone: Fax: Address: City: State: Zip: ❑ Architect: Phone: Address: City: State: Fax: Contact: Evan Hughes Zip: HEIGHT TO PEAK: 19'-6 3/4" DIMENSIONS: 50'-0" x 55'-0" # OF STORIES: 1 MAIN FLOOR TO SQ. FTG: 1606 SF ot` 2N° FLOOR SQ. FTG: N/A UNFIN BASEMENT SQ. FTG: N/A FINISHED BASEMENT SQ. FTG: N/A GARAGE SQ. FTG: 660 sf o f� DECK/COV. PATIO SQ. FTG: 9a OCCUPANCY GROUP: Single Family CONSTRUCTION TYPE: Residential HEAT SOURCE: GAS # OF BEDROOMS: 3 TOTAL HABITABLE SPACE: 1606 sf IMPERVIOUS SURFACE AREA: COST OF PROJECT: $195,000 30% SLOPES ON PROPERTY: NO SEWER OR ON-SITE SEPTIC SYSTEM? Sewer Width: Manufacturer: Length: Year: Pit Set: Previous Address: Proposed Use: Fire Sprinkler: Tent: Valuation: Plans Examiner: Address: Inspector: Address: # of Heads Fire Alarm: Fireworks Display: Blasting: Above/Underground Storage Tank Size: Paint Booth: Date/Time: WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE Phone: City, State, Zip: Phone: City, State, Zip: Fax: Fax: ❑ BOLTING ❑ CONCRETE Firm Name: Inspector(s): ❑ REINFORCEMENT Phone: Fax: ❑ WELDING DISCLAIMER 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. Ownership of resulting development rights granted by any issued permit -inure to the, props y owner. Print Name kr S I»Zv('i & Signature t_ Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other Bankcard #: Expires: Authorized Signature: VIN#: g 29 02 08:49e Dan Canis • 509-755-6713 2001 WSEC Residential Compliance Form Prescriptive (Chapter 6) Options far all R Occupancies, Climate Zone 2 0, 1 Heat source• A T p- 1 • 't.CE: 'a'°�:�21g3 "Fs 7z: s tib= _ .:ter r..r...'3i;e;c •.�.._.w�...�d •.cam - _ ._�.' t=,�cy,dv=±cru, �:3G mIsna MONS i7 1) Yots rTnitw2Zl be processed more efficiently if you provide all.of the'requeste-d infonriation_ l ei-a risme__ staff (:-"n help you with general ilnestions about this fora_ Your building must matchthe selected option requirements without exceptions orsahsfitu ions. 2) Glazing percentage determines whicch option to choose_ Complete the following glazing area calculation b fore- praceori-ing to the option table below_ V GLAZING AREA CALCULATION: (1 o SF. b3 SF. - f(� o -r TOTAL WINDOW AREA-." . _.---..._:_ HEATED F-LogR ARE4 Lail FLOCKS)_^--°4i9F • g NOTE Use rurlghoperiing(R/O) for window area Irtiricleall half -lite and iti-lite.doorolt? rginthis calcvlatiorL CANT-COMJ'LY? If none of the Prescriptive (C'hpter ) Options below are acoptabler consider spsthls analycis (Chapter 4) or, Component Performance (rl-,apter 5) Approach- The mann adirallage is fleaibilitjr to juggle individual U factors (R -values) as long as an overall ma>5mum lydlae isn't exuded- Note that the overall pe:Eo#nance iego er,ts are ilo less stringent _Tern the Presuiptive requirements_ Calculations may be performed by hand or using an acceptable coMputer software program. Helpful forms and other resources can be downloaded at http://www_ ergy wstz.edu/ buildings j �w.�rY..���E.1�,c.Y.- . .ter• .CIRCLE OPTION • TABLE &-2 • PRESCRIPTIVE' EOUIREMENTS5.4 FOR GROUPR;OCCUPAUCY CLIMATE ZONE 2 �pGon 6Glaazio,g of.Poor Gla too U--Fer�r a boar ;�cTn . 13 -Factor t Vaulted C&T.19 Wall • Grade Wall. kir Eli.5W Grade Wa[I. �d� B-ae owe Grade I .Flours I Slab fri- 'Grader -Vertical Overhead" r S - '10 + ' 0.40 - 1150 0_11 11-32 11-30 R-221 11-21 . A-12 A3 i R10 - 25'5 040 058 -020 R-36. .. 5-30 R-29+ R-5. R2I -R-72 R-36, 1010 )1r �!' • 17%, • 037 • 115E 020 E--38 11-30 11-19+ R -2I R-12 R-301 R-10 Unautca . rannplt3- .0cenpancy Only 035 OSe 01 - ' 8-s5 . R-30 11-21 ice' 1-21 31-12 8301 A-10 • 0. Nominal JL -tames are farwood franc assemblis.oaly or asscrobii6 builr in nreortimzee with Section 601.1_ 1. Minimum requi*emen+s for each optionlisted_ or rxntnple, if a. proposed. design has a pb-ingratio to the caaditionod floor arra of 13%; it then comply with ail oftholognircmrnis of the.l5%.glacng option (orbighcr). Proposad-deagns which cannot meet the specific requirements of a listed option above may =imitate compliance by Chapters 4 or 5 of this Code. 2. RrxlobrmcniappliestoallcolTmg3ezcptsinglerafterorjoistvaulitdcaging. Add.draotesAdvanc dFramedBing_ 3. Regc r-m,fnt appL blc only to single rafter orjoutvmitrd c aI o • • 4.. Bcloveg ode walls shall be ittsuintedath¢on rbc ecicoor to a rni„im„m level of11:l d, or on ib= mister to the same tend e5 wails.nbove grade. '_Pxtraior ins ulctirorinstcIlcd on below grade walls sball be a water resissmt material, manufactured for is intended us; and installed accordbs to themanufacturcr's sp-cifioolicr s ScSection 602 5. Fltwrs over -crawl spaces or r..oscd to ambient air condition • 6_ Required slab paimct= inrulatioa shall be a aatcrrrcisr,,..r material, msnnfacnucd for its intmdru use, and inacdl ed according to ranu$trnitet'5 spcciiirations: See Section 602_41 • . - . ' . • 7. hit denotes standtrrdsnmmg 16 inches on coni -r with betides -insulated a minimum ofR S irsdaooa_ 5_ : iswaliinsutarionicquircmcotdmates11-l9 wall cavity insulation piusT-5fozmtheaihing. 9. Doom, ioctoding all fire doors, shall be assigned default IT -factors from Table 10-6C. 10. Where amarimtrm glazing area 'is listed, tar tort.glazing arra_ (combined :eritralplus overhead1 as a percent ofgross condition 3-7oorcrraahallbelees1Fkartorcgoalwthatveloc. Otrcrheddglarigwith U-factorofII 0.40erlessisDotinoludcd in glazing arra limitations .11. Ovctbrad glc ng shall bare TT -farina determined ter ordancc wittNPRC 100 or as svccified in Scctioa 50- 15- 12, Log and solid timber wails with timbal -mum avcraec tldrtorss of33 are c:ernpt from this iacoition rcquir®cam ATT(;-rlo_nrl TTITT n7. of All t'DnU. inn fcG 6,710 Tr1 . n r nT a 4 SULLIVAN HOMES INCORPORATED TRANSMITTAL SHEET TO: CITY OF SPOKANE VALLEY FROM: Sullivan Homes CONTACT: EVAN HUGHES DATE: 5/18/06 PHONE NUMBER: 509-624-4598 RE: 17215 E Nora Ave Building Permit 0 URGENT X FOR REVIEW 0 PLEASE COMMENT 0 PLEASE REPLY 0 PLEASE RECYCLE CONTENTS: (2) FULL PLAN SETS 24" X 36" (2) PLOT PLANS (1) BUILDING PERMIT APPLICATION (1) MECHANICAL PERMIT APPLICATION (1) PLUMBING PERMIT APPLICATION (1) RESIDENTIAL COMPLIANCE FORM (1) GENERAL FACILITIES CHARGE ***PLEASE CONTACT US IF ALL OF LISTED ITEMS ARE NOT INCLUDED*** 16114 E. INDIANA AVE, SUITE 200 • SPOKANE VALLEY, WASHINGTON • 99216 PHONE: 509.624.4598 • FAX: 509.624.4630 11 It PLUMBING PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 Project Address: 17215 E Nora Ave 99216 Owner: Sullivan Homes Mailing Address: 16114 E Indiana Ave City Contractor: Sturm Heating & Plumbing 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 License #: STURMI*210QF 4505 1112 N. Nelson, Spokane WA 99202 Phone #: 325 - 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 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 4 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 DISPOSAUSYS X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 = METHOD OF PAYMENT: ❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD DATE: EXPIRES: SUBTOTAL PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: MECHANICAL PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, CaII (509) 688-0054 Project Address: 17215 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 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 3 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 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: r irecu n ruFctc fl VISA f1 MC DATE: SUBTOTAL PROCESSING FEE $35.00 CARD #: EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: