2004, 03-08 Permit App: BLD-04-03722 AC03/08/2004 12:10 5094841505
City of ..'
SPOKANE .ALLEY
RR HEATING
PLUMBING /MECHANICAL
PERMIT APPLICATION &
PERMIT #
Contractor: tifOrntatio>t':
j 4q 03: °..
Job Addrss
Contractor's Haines:
Y019 : �.enfra,(
Conititclor' address
City Zip Code Owner phone number
1/451 0S --
Contractor ;Phone Number:
`Applicant Information
Owner Name
a.>.1_3 5
Owner's Address
sp�ky„�,l.�tl�r,C w!i- 9f? -d4
City Zip Code
PAGE 03/03
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"tee: ••••.; •
'
Number — Furnace (up to 100,000 btu)
— Gua llot Water.Keiter ' :: ' : .
Total
Coot( Top Ar:otli l'•sppliances
Clotlitsdryer.''r_ ":•
G`cnversiu* burner..,:
Gas log's, gin fireplace insert
Wood stove aystem. ,... .. • .
: Appuaiue*nt: 0144r - relocation
: Liulidry WasiitrY sink.
A)C`udit'((u¢?tti 3 toM )
Unit Beatir:� (up.to:100,000 btu)
Fireplace iisert (wood– pellets) •
Evaporative coolers •
Commercial, hood
ncpaust:ventt ;
Ducts
•
•
Gni 1nobtg c ' of is) .•
• • ' • (5;i::foi•eve'}%oiitletafter4)
Total
515.
$10..0
•S1O."ea
':.$10. ea
*10. .
S10.ea
525. .
S7.s0 ea.
S 10, ea
IZr ea
S10: ea
312. ea
$12. ea
8. ea
'512.
9 5. up to 4 outlets
. :Fee .GostS:i•; a s :' . •• ;.Fee Cost $
Plumbing
Number
Basic fee
Toilets Urinals
Tub & faucets
Shower heads
Bathroom sinks
Kitchen *Op
Dishwashers
$35.
$6.ea
S 6. ea
S6,ea
S6.ea
S6.ea
S6. ea
Hot water tank $10. ea
Lawn sprinkling system S25.
Privatesewage system VOL
Vacuum type breaker (5) S25..
Drinking fountains S 6. ea
Floor Drains'. S 6. ea
Sump • S 6. ea
— Raekllow.preveutor .. $ 6. ea
— pdpe-dralimge repair S 6. ea
Rose Bib 5 6. ea
I hereby nathorize the City of"SPtikaae "Italley,fo.chharge the fec'for title, permit to my credit rai d :
VLsa Mastercard, -No:
Print name ofliotder
•
Signature
17 )-7 OC
Total S
Date
HO1Vi�QVVNEI2 ]NBT ILER c NY,Y..
1 beteby..certifyillIttI.amt.4•o :orthe pbperiy described in this applic:}tittn. I understand that •
rhe work is subject$o.:lnspgcllaii and e.pp�ovat bythe City;ofSpokane Valley, and that I may not allow any
oilier person, itiolua►b a lfcens deonfractor,;fo do a,ay work under this purNL
Signature ?f owner
FOR OF'FXCE USE .ONL'.
+.bate
Date recdved Circle onr..c ;Plumbing Mecbanlcal
SupplementalioperinttNumber: ";' : Date Permit Issued
Permit Number Fee collected $
•
Issued By:. .
s-vzne-pl
MAR 08 2004 11:1?
Date •
5094841505 PAGE.03