2004, 03-03 Permit App: BLD-04-03680 AC 03/03/2004 14:46 5094841505 RR HEATING PAGE 01
, 4PPERMIT APPLICATION &
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- - - - - 'ERJT #
Contractor Information Applicant Infor mtior.
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Job Address Owner Name //
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Contractor's Nam
� 6 /1€4 l 5 15�1 Sa�ir,an "rl;i�CY LesOwner's --
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Contractor's address C 5Pa LA�e- w 'geld/
• Ctty ip Code
ce o AA) "(.vA- 99x-17 9,01y 7Voy
City •
1/ Zip Code Owner phone number
Contractor Phone Number Tax Parcel Number(Assessors Number)
Contractor's registration card(or copy)must be presented at
_ - - - - _ time of submittal
Fixture Count/Schedule of Work
Mechanical Basic fee • $35. Plumnirg Basic fee $35.
Number Furnace (up to 100,000 btu) $15.ea Number
Gas Hot Water Heater Toilets rivals S 6.ea
S10.era Tub&faucets S 6.ea
Cook Top&other appliances $10.ea '_- Shower heads S 6.ea
Clothes dryer " S10.ea _-_ Bathroom sinks S 6.ea
Conversion burner 510. Kitchen sinks S 6.es
Gas logs,gas fireplace Insert $10.ea Dishwashers S 6.ea
Wood stove System 525. • _- Rot water tank 510.ea
Appliance veal repair-relocation S 7.50 ea. Lawn sprinkling system 525.
Laundry Washer/sink S 10.ea _ Private sewage system 520.
_' A/C unit ((up to 3 tons) 512. vacuum type breaker(5)$25.
Unit Heater (up to 100,000 btu) 512.ca Drinking fountains S 6.ea
Fireplace insert(wood-pellets) S10.ea Floor Drains $6.ea
- Evaporative coolers $12.ea - Sump $6.ea
Commercial Rood 512.ea - Backflow preventor S 6.ea
Exhaust vents $8.ea
Ducts System p pe drs inzge repair $6.ea
Y 512. Hose Blb
Gas Pip ng ( cetletc� i S 5. , " d out= -_ S G.ea
•" (5 1.for every outlet after 4)
Total
•Total 5 (./7 d1
1 •i
Fee Cost S " �� Fee Cost S 3jaVF Tows
S !
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: �pry f•,&6
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Visa Mastercard No.
Print name of holder Signature
•Signature of applicant ' ' Date
• HOMEOWNER INSTALLER ONLY
I hereby certify that I am the owner of the property described in this application.:understand that
the work is subject to inspection and approval by the City of Spokane Valley,and hat?may not allow any
other penson,including a licensed contractor,to do any work under this permit
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Signature of owner pate
FOR OFFICE USE ONLY
Date received Circle one: Plumbing ?riecbanicat " Both •
Supplemental tc Permit Number: " Date Permit Issued
Permit Number Fee collected I:
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Issued By:" ' Date
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s-vme-p1
MAR 03 2004 13.51 5094841505 PAGE.01