2003, 03-31 Permit App: BD03-006 Plumbing Reversal City of PLUMBING/MECHANIC,' L
SPOKANE VALLEY PERMIT APPLICATION & O(I ...5S0
PERMIT # D3 ()QC()
Contractor Information Applicant Informatio
Job Addre s Owner Name
/ /mss /ti,/1- /59' 06 E /1n'
Contractors Names, Owner's Address '
707 C-. 9/9/-1- ,O //ca,!,,2' a-4-4<4 `7 2J9--
Contractor's address C' e- Zip Code
s�� �.-- Vic/ 7Y7 �<�;_
City Zip Code Owner hone number
56..27.��2 a�05 z3 0v7s 3 .a 47/,/7/7
Contractor Phone Nu er 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. Plumbing Basic fee $35.
Number _ Furnace (up to 100,000 btu) $15.ea Number _ Toilets Urinals $6.ea
Gas Hot Water Heater $10.ea _ Tub&faucets $6.ea
_ Cook Top&other appliances $10.ea - Shower heads $6.ea
_ Clothes dryer $10.ea - Bathroom sinks $6.ea
_ Conversion burner $10. - Kitchen sinks $6.ea
_ Gas logs,gas fireplace insert $10.ea - Dishwashers $6.ea
_ Wood stove system $25. - Hot water tank $10.ea
_ Appliance vent repair-relocation $7.50 ea - Lawn sprinkling system $25.
Laundry Washer/sink $10.ea _ Private sewage system $20.
_ A/C unit ((up to 3 tons) $12. _ Vacuum type breaker(5)$25.
_ Unit Heater (up to 100,000 btu) $12.ea _ Drinking fountains $6.ea
_ Fireplace insert (wood-pellets) $10.ea _ Floor Drains $6.ea
Evaporative coolers $12.ea Sump $6.ea
_ Commercial Hood $12.ea Backflow preventor $6.ea i,
_ Exhaust vents $8.ea _ pipe-drainage repair $6.ea
Ducts system $12. _ Hose Bib $6.ea
Gas Piping ( outlets) $5.up to 4 outlets
($1.for every outlet after 4)
Total
Total _ � �
Fee Cost$ Fee Cost$ Total$ `-(1,0Z-)
1 hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard No. ___ Expiration date
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.I understand that
the work is subject to inspection and approval by the City of Spokane Valley,and that/may not allow any
other person,including a licensed contractor,to do any work under this permit.
Signature of owner Date
FOR OFFICE USE ONLY
Date received Circle one: Plumbing ,:'i Mechanical Both
....,
Supplemental to Permit Number: pitie Permit Issued -3/-03
Permit Number Y)3 --(10Ce Fee collected$ "1-#. 0 D
Issued By:( ' k-, Z(_20 Date 3-3/-03
s-vme-pl