2005, 05-02 Permit App: 05001384 ROW, Plumbing Reversal*lane
.00Valley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF. PUBLIC WORKS
ES --/3K1
Anticipated start date
Permit #
ROW CONSTRUCTION PERMIT
Location of property 9/ ,
(Address/Parcel #, If available)
Applicant Name Fax
Address
Contractor's Name
Address
Phone
(ion,77-0eTicyti
Po. /3`f / Phone 29/-995/?
/7
Contractor's Reg.# 2 BE,z5TO -*(y)%Xj Jce Expires ca - M41 CU
PROJECT DESCRIPTION (Provide
Ad'S-;;Ver Connection
• Curb & Gutter
n Cable/Conduit/Pole
Ti Water Installation/Repair
n Pavement Cut
site sketch or plan as necessary for clarity)
ElDriveway
n Gas Installation/Repair
• Sidewalk Repair/Construction
ri Other
Dimensions
Bond/insurance certification must be on file with the City. Bond #,
Permittee Signature Approved
Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card # Expiration Date
Name of Holder
Signature
Fees Paid$
(Application) (Inspection)
Date
!nit
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here _ ,3 �3/
PERMIT MUST BE KEPT ON SITE
Excerpts from Spokane Valley Standards (3.24, and details A8 and A -8a):
• Every driveway approach must provide access to an off road parking area located
on private property. The driveway shall be of sufficient length so a vehicle In the
driveway does not project into the road right of way, sidewalk, or pathway.
• Public or private driveways in industrial, commercial, multiple family, church or
any like use shall be constructed to allow vehicles to exit without backing onto a
public road.
• Driveway approaches shall be constructed to avoid interference with existing
drainage inlets, culverts, road lighting standards, utility poles, traffic regulating
devices, fire hydrants or other public utilities. The applicant shall bear the cost of
relocating any such public facility.
• Driveway approach grades within the right of way shall not exceed 8% in urban
area, or 2% in rural areas. Driveway grades shall not exceed 10% within ten feet of
a city right of way.
See Standards for a more complete listing of requirements.
PLUMBING PERMIT APPLICATION
ne Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, CaII (509) 688-0654
Project Address:
G �IL-4f f•L��'� Permit Use:
C � -'
Owner:
Mailing Address: "7,c=
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
29'11-7a92
4,�' -__ , Phone (Daytime Contact):
City �/ State Zip Code r
Licen #: 177t SLI /y' Phone #:
ityy ti), 99ai State Zip Code
Contractor: Z -
Mailing Address:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
N OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
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
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
NSTALLATIONTION, REPAIR,
EVES
/
X
$6.00
=
'''''-n'
v //'..
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
ti
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
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
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
/,
/1file 0
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: