2003, 03-31 Permit: 03-004 Mechanical FixturesCity Of
SPOKANE VALLEY
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Contractor Information
Job Address
Contractor's Names
Contractor's address
City Zip Code
Off-- 3-2--2
PL UMBING /MECHANICAL
PERMIT APPLICATION
PERMIT # o
p cant Information
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Owner Name
/yRO- y �;- z/ Ct--
Own 's Address
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City Zip Code
S0'9' -- yzz - elo 7 a
Owner phone number
Contractor Phone Number
Tax Parcel Number (Assessors Number)
Contractor's registration card (or copy) must be presented at
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V
of submittal._____________________________
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Fixture Count/Schedule of Work
Mechanical Basic fee
Number Furnace (up to 100,000 btu)
$35. Plumbing
$15. ea Number _
Basic fee
Toilets Urinals
$35.
$ 6. ea
- Gas Hot Water Heater
$10. ea
Tub & faucets
$ 6. ea
Cook Top & other appliances
Clothes dryer
$10. ea _
$10. ea _
Shower heads
Bathroom sinks
$ 6. ea
$ 6. ea
Conversion burner
$10.
Kitchen sinks
$ 6. ea
G+
Gas logs, gas fireplace insert
$10. ea
Dishwashers
$ 6. ea
_
_ Wood stove system
_
$25.
Hot water tank
$10. ea
`C
Appliance vent repair - relocation
$ 7.50 ea
Lawn sprinkling system
$25.
v
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
V
Evaporative coolers
$12. ea _
Sump
$ 6. ea
Commercial Hood
$12. ea
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 $
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
ant
Signature
13
Date
HOMEOWNER INSTALLER ONLY
I hereby certify that I am the owner of the property described in this application. 1 understand that
the work is subject to inspection and approval by the City of Spokane Valley, and that / may not allow any
of r on, i rcludicensed contractor, to do any work under this ermt.
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Sign tur of Wner Dafe
FOR OFFICE USE ONLY
Date received
Supplemental to Permit Number:
Permit Number -3~ 00
Issued By
s-vme-pl
Circle one:
Plumbin Mechanical Both
Date Permit Issue 3
Fee collected $
Date 3�