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2003, 03-31 Permit: 03-004 Mechanical FixturesCity Of SPOKANE VALLEY ------------------------------------------ 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 �1/lS Owner Name /yRO- y �;- z/ Ct-- Own 's Address �r�t 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 \1Z � V of submittal._____________________________ . �. ------------ ----------------______=time 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. -- --- - 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�