2003, 04-01 Permit: BD03-035 Plumbing Fixtures 44
City of PLUMBING/MECHANICAL
5)t-k
SPOKANE VALLEY PERMIT APPLICATION & ' L
PERMIT # D 5_ o ; c
Contractor Information Applicant Information
"7 / //4.I1..-TaL,L A!',,,),A!',,,),Job Address ,,// Owner' me
�dn A' -di.r1, 7&/ //��
Contractor's Names Owner's Address
-. 1o3 eJ' /3'zY s,,�.,- .e 1'/Qy -74.71-2Contractor's address Cry / Zip Code
try Zip Code Owner phone number
-2/6 --2.d 7/
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. 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 J Backflow preventor $6.ea
-
Exhaust vents $8.ea _ pipe-drainage repair $6.ea
Ducts system $12. _ Hose Bib $6.ea
Gas Piping ( outlets) $5.up to 4 outlets
($1.for every outlet after 4)
Total
Total _
Fee Cost$ 3�Q Fee Cost$ /' a Total$
I 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 applica 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 I 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 Mechanical Both
Supplemental to Permit Number: Date Permit Issued
Permit Number Fee collected $
Issued By: Date
s-vme-pl