2004, 03-18 Permit App: BLD-04-03801 ACU.i/12T2t7i4 11:17 Jtri4t1410t77
City of
SPOKANE VALLEY
Contractor inforlitatiion
(Pe',a3 SAAnn on A.
Job Address
Contractor's •Karnes
• ti • f- Ce" 76.
Contractor's address
Sp46•L1c,, .6914 91417
City ZO Code
Contractor Phone Number < ...
• Fixture Count /Schedule of Work
. Mechanical • Basic fee•• • • -
Number _ Furnace lap to 100,000 btu )
oas'$ot iter Heater •
Cook Top'& other appliances. ' •
Clothes dryer
Conversion burner :. •
'Gas logs, gas fireplace insert
Wood.store..syste,,n .
`Appliance. Vent repair- relocation.
X,auddryvwasher'tsitik`•
Total
r r nen:111V
PLVMBING /MECH'ANICAL
PERMIT APPLICATION &
PERMIT #
Applicant Information /
'Icj. �ri'4U
Owner's Address
p.lc_4 Vet //e , v„#- 99016
City. Zip Code
Owner phone number
Owner Name
2'
Tax Parcel Number (Assessors Number)
Contractor's registration card (or copy) must be presented at
time of submittal
ea
S10. est
510. ea
510: ea
510.
510. ea
525,
S 7.50 ea.
A/C unit ((up to 3 tons)
'Unit Heater: ( upas 100,000 btu.)' . •:512: ea
Fireplace insert (wood— pellets.)
Evaporative coolers
Commercial good
Eihaust.vents
Ducts system 312.
Gad Plging ( .' outlatk) : "S S. up to 4 o_1r44
(S 1. for everg outlet after 4)
Total
510. ea
312. ea
$12: ea
S.8.ea
:Fee:Cost.S ..
Fee Cost S
I hereby authorize the City of Sp6kaoe+Vagey to charge the fee for this. permit to my credit card :
Plumbing
Number
Visa:. Mastercard No..
Print name of holder Si ature
Signature_ of.applicagt
Basic fee
Toilets Urinals
Tub & faucets
Shower beads
Bathroom sinks
Kitchen sinks
Dishwashers
Rot water tank
$35.
S6. ea
S6. ea
36. ea•
56. ea
S6. ea
56. ea
S10. ea
Lawn sprinkling system 325.
Private sewage system 520.
Vacuum type breaker (5) 525.
Drinking fountains S 6. ea
Floor Drains' S 6. ea
Sump $6. ea
Becht] ow preventor S 6. ea
pipe -drainage repair S 6. ea
Hose Bib . S 6. ea
Total $7
00
Date
ROMEOWNER INSTALLER ONLY .::..
I hereby. certiiy:that1 am tfle owiher.,of the property described in this application. I understand that
the work Is siibject to to :II:de n and:approval iiy die city of S, pokane Valley, and that i may not allow any
otherperson, Including a licensed conaaetor, so do anylwork under thls pernnic
nature of owner
FOR OFFICE USE Q OE .:.
Date received
Aate
Circle one: • . Mum bin
Supplemental to ?ertnit Nutdber: Date Permit Issued
Permit Number
Issued By:.
s-vme-pl
MAR 12 2004 10:25
Date.
Mechanical
Fee collected $
Both
5094841505
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