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2006, 03-24 Permit App: 06000776 Residence Project Number: 06000776 Inv: I Application Date: 3/24/2006 Page 1 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project In formation: mare^��.«r.'„311d;'9""tba§°r.�z2��a„ll'YNatra�111warekwd uG 6n e+�s p�.,.��z� �s,',Ea;�&'tlAm.sik'�,reel Cvdai➢`,,;°g.d sduz..t�'k+Y3,.@arwN3!:ngad,n..ga'�:,re�A xyaa�llitlDX'.�uA�R"s;."�+aatzk5,ckd�kunMat�^Us....Xa!�;:essma �,- .. Permit Use: SINGLE FAMILY RESIDENCE/FORCED AIR- Contact: DMJ INVESTMENTS,LLC GAS Address: 12313 127TH AVE,NE C-S-Z: LAKE STEVENSON,WA 98258 Setbacks:Front Left: Right: Rear: Phone: (509)555-5555 Group Name: Project Name: Site Information: , ... Plat Key: Name: Range District: Sout Parcel Number: 45324.9026 Block: Lot: SiteAddress: 4309 S SCHAFER RD Owner:Name: DMJ INVESTMENTS,LLC Address: 12313 127TH AVE,NE Location::CSV LAKE STEVENSON,WA 98258 Zoning: UR-1 Urban Residential-1 Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Building Plan Review [[ ' i' 4' ' Originally Released: 3/14/2006 By: TMELBOU Driveway/Approache ��o�� I�q Originally Released: 3/14/2006 By: amblake a Septic Sys Review R.eleasecl B ' see approval in file Originally Released: 3/24/2006 By: amblake Landuse/Zoning/HE Conditions Released By: Originally Released: 3/13/2006 By: KKENDAL Operator: AMB Printed By: AMB Print Date: 3/24/2006 Projedt Number: 06000776 Inv: 1 Application Date: 3/24/2006 Page 2 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Building Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 This Application: Total Project: Description Grp Type Notes So Ft Valuation Sq Ft Valuation l- c 1&2 FAMILY R-3 VA 1,306 $119,812.44 1,306 $119,812.44-'s BASEMENT F R-3 VB 640 $12,800.00 640 $12,800.00 t BASEMENT U R-3 VB 640 $9,600.00 640 $9,600.00 DECK OPEN R-3 VB 226 $3,390.00 226 $3,390.00 GARAGE U-1 VB 638 $12,122.00 638 $12,122.00 Totals: 3,450 $157,724.44 3,450 $157,724.44 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $1,318.55 WSBC SURCHARGE 1 SELECT $4.50 SF PLNS RVW<7999 SQ FT 1 SELECT $527.42 Permit Total Fees: $1,850.47 Mechanical Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Item Description Units Unit Desc Fee Amount GAS WATER HEATER 1 NUMBER OF $10.00 GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00 CLOTHES DRYER 1 NUMBER OF $10.00 RANGE 1 NUMBER OF $10.00 Permit Total Fees: $42.00 Operator: AMB Printed By: AMB Print Date: 3/24/2006 Project Number: 06000776 Inv: 1 Application Date: 3/24/2006 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Plumbing Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Item Description Units Unit Desc Fee Amount TOILETSBIDETS 2 NUMBER OF $12.00 SINKS 3 NUMBER OF $18.00 TUBS 2 NUMBER OF $12.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 FLOOR DRAINS 1 NUMBER OF $6.00 Permit Total Fees: $66.00 Right of Way Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Notes: Payment Summary: �� . �,n,.. Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Building Permit $1,850.47 $1,850.47 $0.00 $1,850.47 Mechanical Permit $42.00 $42.00 $0.00 $42.00 Plumbing Permit $66.00 $66.00 $0.00 $66.00 $1,958.47 $1,958.47 $0.00 $1,958.47 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: AMB Printed By: AMB Print Date: 3/24/2006 Projedt Number: 06000776 Inv: 1 Application Date: 03/24/2006 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: - Permit Use: SINGLE FAMILY RESIDENCE/FORCED AIR- Contact: DMJ INVESTMENTS,LLC GAS Address: 12313 127TH AVE,NE C-S-Z: LAKE STEVENSON,WA 98258 Setbacks:Front Left: Right: Rear: Phone: (509)555-5555 Group Name: Site Information: Project Name: Plat Key: Name: Range District: Sout Parcel Number: 45324.9026 Block: Lot: SiteAddress: 4309 S SCHAFER RD Owner:Name: DMJ INVESTMENTS,LLC Address: 12313 127TH AVE,NE Location::CSV LAKE STEVENSON,WA 98258 Zoning: UR-1 Urban Residential-1 Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: Review Building Plan Review Released By:' n! Originally Released: 03/14/2006 By: TMELBOU Driveway/Approach Released By Originally Released: 03/14/2006 By: amblake Septic Sys Review Released By:, see approval in file Originally Released: 03/24/2006 By: amblake Landuse/Zoning/HE Conditions Released By: Originally Released: 03/13/2006 By: KKENDAL Operator: AMB Printed By: AB Print Date: 03/24/2006 Project Number: 06000776 Inv: 1 Application Date: 03/24/2006 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Permits: STIONIONWKWANDMININEMANMAHOZ. Building Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Mechanical Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Plumbing Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Right of Way Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Payment Summary: rra .. wx . . c 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: AMB Printed By: AB Print Date: 03/24/2006 Project Number: 06000776 Inv: 1 Application Date: 3/10/2006 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: SINGLE FAMILY RESIDENCE/FORCED AIR- Contact: DMJ INVESTMENTS,LLC GAS Address: 12313 127TH AVE,NE C-S-Z: LAKE STEVENSON,WA 98258 Setbacks: Front Left: Right: Rear: Phone: (509)555-5555 Group Name: Site Information: Project Name: Plat Key: Name: Range District: Sout Parcel Number: 45324.9026 Block: Lot: e...513,c- ._ \- SiteAddress: 4309 S SCHAFER RD Owner:Name: DMJ INVESTMENTS,LLC Address: 12313 127TH AVE,NE Location::CSV LAKE STEVENSON,WA 98258 Zoning: UR-1 Urban Residential-1 Water District: Hold: ❑ Area: 0 Sq Ft Width: 0 Depth: 0 Right Of Way(ft): 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Review Information: � a d aa m aa� as . e.a � a,au�unia�,�r, a ,.. �. a�aw Review BuildingPlan Review �,!' Released By: i b(.„ Driveway/Approach Released By. Septic Sys Review( ''•\'2' L„ Released By: ,,1 L . .-• _: , •1. Conditi,ns eleas-• irdre117170! • rf• %Mate.A. r- m 3 iZv Operator: AMB Printed By: AMB Print Date: 3/10/2006 A Project Number: 06000776 Inv: 1 Application Date: 3/10/2006 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Building Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Mechanical Permit - Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Plumbing Permit Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 Right of Way Contractor: VALUE BUILT HOMES,LLC Firm: VALUE BUILT HOMES,LLC Address: 4005 E 15TH Phone: (509)217-1441 SPOKANE,WA 99223 NINENEMINNPayment Summary: _cea�F; :. ��i a*»awwu e,„,•i ir~pr a.,'.,.. . , nt.. i; ark;� � mario.`�ai^srr°mirsrniw�i Nrq�tr, 'iaa'a:acasdimar�.��'dire,�.s�ara. ��iww�aa'tair,;�rir ma 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: AMB Printed By: AMB Print Date: 3/10/2006 ® �� Permit Center r SpaCane 11707E Sprague Ave,Suite 106 _ ' NUMBERr(�1 �� Y" j L i Spokane Valley,WA 99206 , P FEE: �*,•�i (509)688-0036 FAX: (509)688-0037 <, r r; 2006 �*ww. kanevallev.ora•Coro ��'`!` Community Development spo >•� --_�,�} ' "I i , II J, H, li 'I''j ' ,H .. Residential Construction `i Ie* (onstrbrltldn o Accessory Bldg Permit Application o Addition/Remodel o Deck ❑ Other: SITE ADDRESS 4 3 b 9 ,c c Lia c c e V ASSESSORS PARCEL NO:' LEGAL DESCRIPTION: Building owner - .: . i,.., . ,. .Co acto . ,, . , .. `6, Name: IJ k _-I..Ides 4-1,x.4 Js. a C Name: 11f.a1A.e B ; ((- 01.-,-ej L L(-- Address: / P.313 07 tie► A-v c A), Address: 4!'cc E r s is city:Lc Jce 5/t c,,e ta t ZiP: `i F2 5--g city: 'p a zip: c/i z Z3 Phone: Fax: Phone: ,. I`)-�/4gf/ Fax: 343 -D ZS...7 Lic No: U et t bi 955 ixp.Date: 67 .r: .1 SM1.. Fr> .r.-c:,._. City Business Lic No: Name: —7-741.4._ --z---a;,ve f Phone: a/7 -rLict/ Describe the scope of work in detail: Cost of Project: $ it/.5-0 peso **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE: F ( yo x�3 I , --2 MAIN OOR TO SQ. 2N�FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE FTG: /306, °K /0 J - 4P /..e2514-0- AREA FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON SQ. FTG: ��{0 6 3 k o K 2j i PROPERTY: #OF BEDROOMS: CONSTRUCTION' TYPE: HEAT SOURCE: �j SEWER ORPTIC 2. W1od,-e FUYcc fJiI. C:4f _ 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.6) Plans or additional information may be required to be submitted,and subsequently approved before this application can be processed. Signature j l._ o-', Date , -/0-6 Method of Payment: (Faxed permit applications will only be accepted with major bankcard) 0 Cash 0 Check ❑ Mastercard 0 VISA 0 Other Bankcard#: Expires: . VINti: Authorized Signature: REVSED srzs2005 -,--;.-±!H SS_ ,2_,:2:::--, S20: :: s.v.-:W 1 ECTIF= I -. .3 FR T7_i 2,115S? P.171 ._- 3,r ,ti 2 I'I, 2i , ,I,I • orciff tl;'TG 1m'; 1 .`1p()11e'1111)11 1);,t;!: Ji)� ntl( l 1 '11tI51S NOT :\ I'ERi11Ii' l't'I1111t1''S will IN.! ;Iti.,;ce�etl flit' cr)m1t►r.ltcillr v,'i)I.it \v iliil)nl a 1i1'r111.1l /'1,i/fI�; (,r!'r rtl rt(i t 711. _.__...-�,.:e.w.,—. ., —...—.. .., ........=—••a-+......M --w--rrx...."-4m..rs..-.-.. ...--...., I>:.11 ,ii l _ i?,;(:I,i: F.0111,1" R1?S►1)Ir;tiCE! I' RCE'1) AIT: Coota-t: I)',I,i i_r'YE``1.;rIl:i 1Tn, I,;,12 11;:\: ,`.dacss: I 1:31_. I27`i ll :\\''T:,\E C_S - LI,Kr,sTI;v 'i SOtN. \` . 9X".:11J _... ..“-J .. I'1 ,t ) I'l)nii: (:‘ ,;55-55,55119) ' 1 , r:iglu- I?�:�r: Group, ')rric: Pt•OICcI i'a1;1i : ,'ti(r: (11/l,6(tt7I1: .. :..._ .. -----._—W......— District: Sow 1'IUi (... i'i:.il n?: 4 f�NiIiC (':n ,,"07111:,c'.r: {';''d 4.)1J2( Block: Lot (~) - > ;,i1"\i -.1 \ -(/) �� `i:_.,dratc,?, 4109SSCiL11'J?I, NI) Ov:rier :unn: U1\1J 11\'\'1;~T;\11":1',"1;;; J,I,t` Add:cs:,: 1211.1 12;7111 ;1.'E, NT, I.Oc.,ti,nl:: C.iV LAKE S'I'EVL SON, \"A '1H 2"a ,,,.oniu,,: i!it-I lJI'Irah It,...::itfnii)l-I :1t:u: 0 ;:ti Fi ,'ic1111:. 0 Del;ll: t) I"'-i;.'ir1 01'kV:1y(it): O ,-1,- r,1"1. 1,1.;.;! 0 i:h- orD'..0,Ilint , it /i t'I,I r')il t,',t ,. r11 i,t!!: ...c•r...m-.--.-.,.-.c......warm-.,,,,—..........--:.f..,.-6.,...,-,.-,,... -.: .........,z^e:_..•xr.*-.rs.-- ^.:. --r--^-.."....r..-s..r.".'....r....t ii.'l ,l• 3 � I!1 11 ',;I,: 11;1 11 1:11%it ,ti' 1 4u1 I -. ?._+7J'.15"1` ': :, !i,' 1_ ' 1 t ,l i! t '', I)I it r:'1'..iy/A ryi.,,:Ir1, (jNel r i.l�lty J "r 1 tci!f 1.1 'r') i) ,,`1 ksr i'� h.:e_,, _,.f di.i. ,.`,1 „,.:•.;J...�.1-.i ti..:-' t\Y S W t,in; .�u: i ,-/-1 i I t ,,rn} tk,.la,ltt ut 111 t'„ HILI IIt• lit- ) ///fff ,�,�1 �, t} 1.' l r 'Y.�kl+cr 1�i1�C4 �r i .�:'. 11?1- 41r` AjI1 •tt J jjr / / 4 �j 'sI1 � ti �\ r)� � rl �t�, l�lr �=�-�1, lel.� l 1�{}��- ��"`,�%�1 _, .- {r 1 ""1111 • I -� �/ _J • L / ��:��f t1. —�• n......�.1�J.!rar-R.n. tR., :^,/:+.ti414Y'!r.'71T�iirmt-A o[VIklilt,'1 ---.=,•. .--).'+�Y . ..............••;111t, 41J1, 01.:7t,,.)r: A'IL'S Priuttd By: .AiAI •t Print Disc : 3/I0/2006 QH-!�'S L :b?ESo= "E SEG;EZ,'Ea 00/N`.. Permit Center *acme11707 E Sprague Ave,Suite 106 PE12IV1I.I.NUMBER y �/ . jr'ValleSpokane Valley,WA 99206 �� (509)688-0036 FAX:(509)688-0037 PERMIT FEE: ConDev n uty Development wwwapokanalley g.com Mechanical Permit Application / ❑ Commercial ('Residential SITE ADDRESS: -S 4 3 d.1 S Gtt [ � t 4v Building()inter .Dr `Zi,...,- r 4- 4w k / L c Name: • Phone: . . Fax: Address: / 3 13 f 997 1 Au., NF cite/t,J e Sieiwt i.f' state: W 4- zip: 4B ZSR Name: U s*-GA-e_ Ch u. 14- Vk cnit {s ac Phone: i 7-iqL.(( Fax: ?Ll,3 - 4 2.x'7 Address: .4D40 E J6-6 City: 'Teo state:444- rip: 2 23 License No: tial t._F h L r1 c c k P Ca%Business License No: Name: ." , u.,` Phone: -2/7 i 14 _DESCRIPTION OF WORK *OF UNITS X COST = TOTAL AMOUNT FUEL BURNING APPLIANCE Equal to or less than 100,000 1 X $12.09 = 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(Add tional 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 = 8 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 = 7 TION 1-100M BTU X , $12.00 = 8 TION 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 Mare than 1.750M BTU X $80.00 = 12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 = 13 RANGE I X $10.00 = 14 DRYER l X $10.00 = 15 FUEL BURNING WATER HEATER l X $10.00 =, 16 MISC.FUEL.BURNING APPLIANCE X $10.00 = 17 GAS PIPING(each outlet) X , $1.00 = 18 DUCT SYSTEMS X , $10.00 = 19 VENTILATING FANS X $10.00 = 20 MR HANDLER(DOES NOT include ducting) awl to or less then 10,000 CFM X $12.00 = 21 MR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 = 22 EVAPORATIVE COOLERS X , $10.00 = 23 TYPE I HOOD X $60.00 =, 24 TYPE 11 HOODX $10.00 = 25 HEAT PUMP/AIR CONDITIONER 03 TON X $12.00 = 28 AIR CONDITIONER 3-15 TON X $20.00 = 27 AIR COMMONER 15-30 TON X $25.00 = 28 AIR CONDITIONER 30-50 TON X $35.00 = 29 AIR CONDITIONER Mas than 50 TON X $80.00 = 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&AOOmONS X $15.00 = 34 VENTILATION SYSTEMS X $12.00 = 35 VENTILATION MECHANICAL E)04AU,ST X $12.00 I. X $19.00 = 38 INCINERATOR-RESIDENCE 37 INCINERATOR-COMMERCIAL X $22.00 METHOD OF PAYMENT: SUBTOTAL ['CASH 0 CHECK O VISA DMC °�'� PROCESSING FEE 00 EXPIRES: TOTAL PERMIT FEE DUE: CARD*: REVISED rams AUTHORIZED SIGNATURE: Wer Permit Center 11707 E Sprague Ave,Suite 106 Spokane valley,WA 99206 PERMIT NUMBER: (509)688-0036 FAX (509)688-0037 Co'nr'a°ntyDeveloPmdrt wwwsookanevallov.org.conl PERMIT FEE: Plumbing Permit Application 0 Commercial &Residential SITE ADDRESS: S 4169 S c CIL_ Ce L- Biuldin gowner I)likkT S i.".‘, 'i4-to ...,4 . L L Name: Phone: Fax Address: 2 /3 „ City:144 t ii-ev a state: (,c,/{4 Zip: fig ass Contractor ft._I Gt.t Rbtl I ti 1 t to ir.w..0 c L L C- Name: '7—'i+,.._ Z--0 we r Phone: ,2 17- I il4/i Fax: 2q3—02 4.7 Address: a 00 E l5'ti- City: Sr 0 State: /AS- tip: Clef 2 2 3 License No: U'A.I IA.# )i.t lSS”' K P City Business license No: Name: —7—; L•- 0 itis s Phone: .7/1- I WI 1 DESCRIPTION OF WORK IS OF UNITS X COST - TOTAL AMOUNT 1 TOILETS WATER CLOSET,BIDETS Z X 18.00 = 2 URINALS X x.00 3 TUBS D- X $6.00 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X_, $8.00 = LAVS/BASINS.BAR,FLOOR,KITCHEN. 5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 = X-RAY,FOOD,PREPICUUNARY MEAT 6 DISHWASHER I x $8.00 = 7 CLOTHES WASHER I , X $6.00 _ = 8 GARBAGE DISPOSAL I x $6.00 = 9 WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $8.00 = 11 FLOOR DRAINS AREA,CASE,COIL.TRENCH,CONDENSATE i X $8.00 = ROOF DRAINS/OVERFLOW 12 DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 = WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR. 14 VENT,PLUMBING,REVERSAL REVERSALS X $8.00 = 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = ICE AN/OR COFFEE MAKER,HOSE BIB. 16 WATER USING DEVICE STEAMER X $8.00 PROOFER,CARBONATOR,SWAMP COOLER VACUUM BREAKER,CHECK VALVE, 17 CROSS CONNECTION DEVICE AND RP.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 = GREASE TRAP,SAND TRAP, 18 INTERCEPTORS CHEMICAL HOLDING TANK X $8.00 = 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = MISCELLANEOUS PLUMBING 20 FIXTURE , X $6.00 = 21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 = INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE 0 CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00 Card* EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED11126,05