2006, 06-05 Permit App: 06002156 Tear Off, Reroof, Plumbing��� �. Permit Center
,Spak11e 11707 E Sprague Ave Suite 1O
Valle Spokane Valley, WA • • 06
Y (509)688 -0036 FAX: (y' 6 7
Community Development www.s okanevalle .0 Ong
1
Reroof Construction
Permit Application
D
JU
Nom.[
RMI
❑ Commercial
[Residential
SITE ADDRESS 1 1 Ll 1 1 A Lk; A V e.
ASSESSORS PARCEL NO: SS / F,3, a a q3 LEGAL DESCRIPTION:
Building owner
Name: (1 1! b n14 ck. r a
y
Address: 1/ L/, 7 AL k I
City :5jckihe IA 411e Zip: ?0/6
I Phone: p� q•/ 7 O Fax:
'on
acct
erso
Name: ?if 1 %r
Phone:
Describe the scope of work in detail:
ontracto
Name: NI j' (9 r A
Address:
VVre_
City: S D K A Y1 e /J4/ iP: ”D/
Phone: 1� / ? ()Fax:
Lic No: Exp. Date:
City Business Lic No:
('Tear off
❑ Overlay
pre'en-i/soh
Cost of project
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is /will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or
additional information may be required to be submitted, and subsequently approved before this application can be
processed.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Signature
Method of Payment: (Faxed permit a
Date 6 /,5": (J 2
lications will only be accepted with major bankcard)
❑ Cash IVA4heck ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN #:
Authorized Signature:
REVISED 8/23/2005
Sgo" new
Valley
Community Devel opment
Fermit Center
1 1707 E Sprague Ave, Suite 106
Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
. rokaneval1ev.or2
Plumbing Permit Application
PERMIT NUMBER:
PERMIT FEE:
Commercial F Residential
SITE ADDRESS: i ! ‘77 L AL/',
Building Owner
Name: L� 1 t �rR LA
I
Phone: 1cA 4/ , ( 1 0 uL.
Fax:
(�.� /� I n
Address: / 1 l / l �7 L kJ,
� j
J 7' J
Ci � d 1�C� h Q 1/C�l /to
State: j •
') `�
Zip: el ?e) /Ce
Contractor L[_, A e r
1. J.
Name:
Phone:
Fax:
Address:
City:
State:
Zip:
License No:
City Business Lic:
Contact
=
Name:
Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
TOILETS
WATER CLOSET, BIDETS
X
56.00
2
URINALS
3
TUBS
4
5
6
SHOWERS ER TRAP
SINKS
DISHWASHER
7
CLOTHES WASHER
8
GARBAGE DISPOSAL
9
WATER SOFTENER
BATH, STALL ON-SITE BUILT
X
$6.00
X
56.00
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
X
X
X
56.00
56.00
56.00
X
56.00
X
56.00
x
56.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
12
ROOF DRAINS /OVERFLOW DRAINS
13
FOUNTAINS, DRINKING
14
WATER PIPING/DRAIN -IN WASTE,
VENT, PLUMBING. REVERSAL
AREA, CASE, COIL TRENCH,
CONDENSATE
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
X
56.00
X
56.00
X
56.00
15
16
17
SEWAGE EJECTOR
WATER USING DEVICE
CROSS CONNECTION DEVICE
GRINDER, SUMP PUMP
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP
COOLER
VACUUM BREAKER, CHECK VALVE,
AND R.P.B-P.D. FOR VATS, TANKS,
BOILERS
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
X
x
$6.00
$6.00
56.00
X
56.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
20
MISCELLANEOUS PLUMBING FIXTURE
21
PRIVATE SEWAGE DISPOSAL/SYS
22
INDUSTRIAL WASTE INTERCEPTOR
X
56.00
X
520.00
515.00
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC
Card#
AUTHORIZED SIGNATURE:
REVISED t126/05
EXPIRES:
VIN:
SUBTOTAL
PROCESSING FEE
TOTAL PERMIT FEE DUE:
535.00
fertn:t Lenter
Sp `�Qe ® 11707 E Sprague Ave, Suite 106
Valley Spokane Valley, WA 99206
(509)688 -0036 FAX: (509)688 -0037
Community Development www.spokanevaTlev.ore
Mechanical Permit Application U Commercial
PERMIT NUER:
PERMIT FEE:
Residential
SITE ADDRESS:
Building Owner
Name: Phone: Fax:
Address: City: State: Zip:
Contractor:.:
Name: Phone: Fax:
Address: City. State: Zip:
License No: City Business Lic:
Contact .. _ _
-r
Name: Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or Tess than 400,00D
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,DOD
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less than 400,000
X
$50.00
=
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$12.00
=
B
BOILER/REFRIGERATION
101 - 5DDM BTU
X
520.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
525.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
560.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
510.00
15
FUEL BURNING WATER HEATER
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
51.00
=
18
DUCT SYSTEMS
X
$10.00
=
19
VENTILATING FANS
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
515.00
=
22
EVAPORATIVE COOLERS
X
510.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
X
510.00
=
25
HEAT PUMP /AIR CONDITIONER
0 -3 TON
X
512.00
=
26
AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
2B
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
525.00
=
33
REPAIR & ADDITIONS
X
515.00
=
34
VENTILATION SYSTEMS
X
512.00
=
35
VENTILATION MECHANICAL EXHAUST
X
512.00
=
36
INCINERATOR - RESIDENCE
X
519.00
=
37
INCINERATOR - COMMERCIAL
X
522.00
=
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC EXPIRES:
CARD ti VIN:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
REVISED 826/05
Project Number: 06002156 Inv: 1
. Application
Date: 06/05/2006 Page 1 of 2
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: TEAR OFF/REROOF /PLUMBING W/ 3 FIXTURES
Setbacks: Front
Site Information:
Plat Key: Name: Range
Left: Right: Rear:
Contact: GRAY, WILLIAM D
Address: 17419 E ALKI AVE
C - S - Z: SPOKANE, WA 99016
Phone: (509) 924 -1902
Group Name:
Project Name:
District: East
Parcel Number: 55183.0243 Block:
SiteAddress: 17419 E ALKI AVE
Location:: CSV
Zoning: UR -3.5
Water District:
Area: 43,500 Sq Ft
Urban Residential 3.5
Width: 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Permits:
Contractor: OWNER
Lot:
Owner: Name: GRAY, WILLIAM D
Address: 17419 E ALKI AVE
SPOKANE, WA 99016
Hold: ❑
Depth: 0 Right Of Way (ft): 0
Building Permit
Firm: OWNER
Phone: (000) 000 -0000
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
1 &2 FAMILY R -3 VB REROOF 0 $1,200.00 0 $1,200.00
Item Description
RESIDENTIAL PERMIT FEE
WSBC SURCHARGE
Contractor: OWNER
Totals: 0 $1,200.00 0 $1,200.00
Units Unit Desc
1 SELECT
1 SELECT
Permit Total Fees:
Plumbing Permit
Firm: OWNER
Phone: (000) 000 -0000
Fee Amount
$69.25
$4.50
$73.75
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 1 NUMBER OF $6.00
SINKS 1 NUMBER OF $6.00
SHOWERS 1 NUMBER OF $6.00
Permit Total Fees: $18.00
Operator: AMB Printed By: MTK Print Date: 06/05/2006
Project Number: 06002156 Inv: 1
Notes:
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 06/05/2006 Page 2 of 2
Payment Summary:
Permit Type
Building Permit
Plumbing Permit
Fee Amount Invoice Amount Amount Paid Amount Owing
$73.75 $73.75 $0.00 $73.75
$18.00 $18.00 $0.00 $18.00
$91.75 $91.75 $0.00 $91.75
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: AMB Printed By: MTK Print Date: 06/05/2006