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2004, 03-03 Permit App: BLD-04-03681 AC 03/03/2004 14:46 5094841505 RR HEATING PAGE 02 City of ,. ` PLUMBING MECHANICAL SPOKANE VALLEY PERMIT APPLICATION & 4)\0)..z. PERMIT # - _ • • Contractor Information Applicant Information. T' 7Li<v C• /I/te �Jat4an 011 Job Address Owner Name J ilea 4' Contractor's Names Owner's Address O /r • 1019 F. • Ce.fi / .gyp A_L- w 9r r� Contractor's address Civ is _ 14:3.17 SYS----c•e `p Cade City Zip Code Owner phone number gyp- /VoS Contractor Phone Number Tax Parcel Number(Assessors f*tmber) • Contractor's registration card(or copy)must be presented at time of submittal • • Fixture Count/Schedule of Work Mechanical Basic fee 535. Plumbing Basic fee 535. Number - Furnace (up to 100,000 btu) S15.ea Number Toilets Urinals S 6.ea - Gas Hot Water Heater S10.ea _-_ Tub&faucets 5 6.ea • Cook Top&other appliances $10.ea Shower beads S 6.ea Clothes dryer $10.es Bathroom sinks S 6.ea Conversion burner . £10. Kitchen sinks S 6.ea Gas logs,gas fireplace Insert 510.ea '- Dishwashers S 6.ea Wood stove system S25. N Hot water tank $10.ea Appilanec vent repair-relocation S 7.50 ea. Lawn sprinkling system S25. Laundry Washer/sink $10.ea _-- Private sewage system $20. ,. . A/C unit ((up so 3 tons) 512. - Vacuum type breaker(5)S25. Unit Hester (up to 100,000 btu) S12.ea Drinking Drinking fountains S 6.ea Fireplace insert (wood-pellets) £10.ea Floor Drains S 6.ea Evaporative coolers $12.ea Sump $6.ea - Commercial Hood 512.ca Backflow preventar S 6.ea - Exhaust vents $8,ea pipe drainage repair 5 6.to Ducts system S12. Hose Bib S 6.ea - Gas miring ( outlets) S 5.up to 4 outlets (5 1.for every outlet after 4) Total Total _ 47� Fee Cost 5 S . ha'er Fee Cost S 3 Total S I hereby authorise the City of Spokane Valley to charge the fee for this permit to my credit Ctrs: CCA) f,c,,) Visa Mastercard No. Print name of holder -,Signature--...= . • Signature of applicant :,ate .4, __ - „- HOMEOWNER INSTALLER ONLY . I hereby certify that rare 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 ,Dare FOR OFFICE USE ONLY • Date received Circle one: Plumbing _Mechanical Both Supplemental to Permit Number: - Date Permit Issued Permit Number Fee collected S • Issued By:. Date s-vme-pl MAR 03 2004 13:52 5094841505 PAGE.02