2005, 04-21 Permit App: 05001364 Residence W/Garage1 . BUILDING PERMIT APPLICATION
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Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
one: (509) 688 -0036; Fax: (509) 688 -0037
REQUIRED SITE INFORMATION
Street Address: / D 0 '3 E d L l< L GR FEN R C I ES
Assessor's Tax Parcel Number(s):
Legal Description: () p
PERMIT DESCRIPTION: ') S W f '4 I 6 2K
[Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: 13vb op,, LA
Phone: Ifiq Pia" Fax: 91y aS'iD
Address: 8 o K 6 3 3
()erode Le 1,."74 91037
City State Zip Code City
Contractor: 1R o I A LL 0 d-/< )�foutt�.di -Shc❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
❑ Applicant: i3 e h Po L L m c%
Phone: T69 Fax: 9,2-Y 9- 5 D
Address:
State Zip Code
City State Zip Code City State
WA State Contractor License #: ()AL.r! C l3 / 9 57.1 r Contact: /361, d OLL o t <
Spokane Valley Bus. Liscense #: Contact:
Zip Code
PERMIT /BUILDING INFORMATION
HEIGHT TO PEAK: l / ;� "
l'
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:,,
/.`ro
2 "" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: / l
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR N -SITE SEE
SYSTEM?
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above /Underground Storage Tank Size:
WASHINGTON STATE NON - RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
Fax:
city
Phone:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
n BOLTING n CONCRETE
Firm Name:
n REINFORCEMENT
Phone:
Inspector(s):
Fax:
n WELDING
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.
Ownership of resulting dePoLt_ok elopment rights granted by any issued permit inure to the property owner.
l-�
Print Name o b Signature X02► -�
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN #:
Authorized Signature:
PLUMBING PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688 -0037
For Inspections, CaII (509) 688 -0054
Project Address: l D d 1 A 1. 1/ Permit Use:
Owner:
Mailing Address:
City
License #:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact):
Contractor:
State Zip Code
Phone #:
Mailing Address:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X -RAY, FOOD, PREP /CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
1
X
$6.00
=
8
GARBAGE DISPOSAL
/
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS /OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING /DRAIN -IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN /OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Project Address:
Owner:
Mailing Address:
Contractor:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688 -0036; FAX: (509) 688 -0037
For Inspections, CaII (509) 688 -0054
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact):
Mail ng Address:
License #:
City
Phone #:
State
Zip Code
DESCRIPTION OF WORK
- ,
# OF UNITS
X
.,,o«
COST
=
up uoae
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 less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
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
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
/
X
$10.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
$1.00
=
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
$15.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP /AIR CONDITIONER
0 -3 TON
i
X
$12.00
=
26
AIR CONDITIONER
3 -15 TON
X
$20.00
=
27
AIR CONDITIONER
15 -30 TON
X
$25.00
=
28
AIR CONDITIONER
30 -50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
33
REPAIR & ADDITIONS
X
515.00
=
34
VENTILATION SYSTEMS
X
$12.00
=
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
=
36
INCINERATOR - RESIDENCE
X
519.00
=
37
INCINERATOR - COMMERCIAL
X
$22.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MC
CARD #:
SUBTOTAL
DATE:
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
This site plan is being submitted ter She obtaining a building permit and is • Y1 d purpose rr ct
representation of the ro and correct
lines /di , pO • N known property
mansions, Curb lines, structures end easements
have been identified. so indicated are wen,,,
bodies of water, steep lopes other critical a,,,,,,
Signed: '''"�'.;
Date:
Q
ROAD Witlif
FROply =you p �.,�``�`
CO ME�� �-
REVIEWED By
This site plan is being submitted
repres'entaa building permit andd at land eel rco rect
tbn of the propoyt. AN lines(d s, curb lines, structures de easements
have been identified asa are easements
so indicated are wl aie.:.
bodiy of wafer, steep lopes other cnticat an:.,,,
Signed: i', -4 •
Dale: Al -a-Sf as-
oI
Project Number: 05001364 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/28/2005 Page 1 of 4
Project Information:
Permit Use: NEW RESIDENCE W /ATTACHED GARAGE -
NATURAL GAS
Setbacks: Front 38 Left: 9 Right: 18 Rear: 100
Site Information:
Plat Key:
Name: RANGE
Contact: POLLOCK, ROBERT K & CAROL
Address: BOX 633
C - S - Z: SPOKANE VALLEY, WA 99037
Phone: (509) 869 -1421
Group Name:
Project Name: ROW
District: East
Parcel Number: 55184.1446 Block:
SiteAddress: 18008 E ALKI AVE
Location:: CSV
Zoning: UR -3.5 Urban Residential 3.5
Water District:
Lot: 4
Owner: Name: POLLOCK, ROBERT K & CAROL
Address: BOX 633
SPOKANE VALLEY, WA 99037
Hold: ❑
Area: 19,990 Sq Ft Width: 104 Depth: 192 Right Of Way (ft): 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
Review
Site Plan Review
Released By:
Plan Review
Released By:
Approach / Drainage
Released By:
L.
Septic System Review
Permits:
Operator: K_C Printed By: K_C Print Date: 04/28/2005
Project Number: 05001364
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/28/2005 Page 2 of 4
Contractor: OWNER
Item Description
APPROACH INSPECTION
CONST IN ROW - APPROACH
Contractor: OWNER
Group: R -3
Total Area
Building Height
Stories
Dwelling Units
Type: VB
1550
17
1
1
Description Grp
GARAGE U -1
RESIDENCE R -3
Approach
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
Permit Total Fees:
Building Permit
Fee Amount
$25.00
$25.00
$50.00
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
Type Notes
VB
VB
Item Description
RESIDENTIAL PERMIT FEE
STATE SURCHARGE
RESIDENTIAL PLAN REVIEW
This Application:
Su Ft Valuation
672 $12,768.00
1,550 $115,754.00
Total Project:
Su Ft Valuation
672 $12,768.00
1,550 $115,754.00
Totals: 2,222 $128,522.00
Units Unit Desc
1 SELECT
1 SELECT
1 SELECT
Operator: K_C Printed By: K_C
Permit Total Fees:
Print Date:
2,222 $128,522.00
Fee Amount
$1,156.15
$4.50
$462.46
$1,623.11
04/28/2005
Project Number: 05001364 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/28/2005 Page 3 of 4
Contractor: OWNER
Item Description
GAS WATER HEATER
GAS APPLIANCE <= 100,000BTU
GAS PIPING
HEAT PUMP OR A/C 0 -3 TONS
VENTILATING FANS
CLOTHES DRYER
RANGE
HOOD -TYPE II
Contractor: OWNER
Item Description
TOILETSBIDETS
SINKS
SHOWERS
TUBS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
WATER USING DEVICES
Operator: K_C
Mechanical Permit
Firm: OWNER
Phone: (000) 000 -0000
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
3 # OF UNITS
1 NUMBER OF
3 NUMBER OF
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Units
3
4
1
1
1
1
1
2
Permit Total Fees:
Plumbing Permit
Fee Amount
$10.00
$12.00
$3.00
$12.00
$30.00
$10.00
$10.00
$10.00
$97.00
Firm: OWNER
Phone: (000)
Unit Desc
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
NUMBER OF
Permit Total Fees:
Printed By: K_C Print Date:
000 -0000
Fee Amount
$18.00
$24.00
$6.00
$6.00
$6.00
$6.00
$6.00
$12.00
$84.00
04/28/2005
Project Number: 05001364 Inv: 1
Notes:
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 04/28/2005 Page 4 of 4
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Approach $50.00 $50.00 $0.00 $50.00
Building Permit $1,623.11 $1,623.11 $0.00 $1,623.11
Mechanical Permit $97.00 $97.00 $0.00 $97.00
Plumbing Permit $84.00 $84.00 $0.00 $84.00
$1,854.11 $1,854.11 $0.00 $1,854.11
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: K_C Printed By: K_C Print Date: 04/28/2005
05/05/2005 14:21 5093241567
Project Number: 05001364 Inv: 1
SRHD EHS
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW RESIDENCE W /ATTACHED GARAGE - Contact: POLLOCK, ROBERT K & CAROL
NATURAL GAS Address: BOX 633
C;- S - Z: SPOKANE VALLEY, WA 99037
Setbacks: Front 38 Left: 9 Right: 18 Rear: 100 Phone: (509) 869 -1421
Group Name:
Site Information: Project Name: ROW
PAGE 01/01
Date: 04/28/2005 Page 1 of 4
e
Plat Key: Name: RANGE
District: East
Parcel Number 55184.1446 Block:
SiteAddress: 18008 E ALKI AVE
Location:: CSV
Zoning: UR -3.5
Water District:
Urban Residential 3.5
Lot: 4
Owner: Name: POLLOCK, ROBERT K & CAROL
Address: BOX 633
SPOKANE VALLEY, WA 99037
Hold: ❑
Area: 19,990 Sq Ft Width: 104 Depth: 192 Right Of Way (ft): 0
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review Information:
9E182 Ni
Review
Site Plan Review
t!, k;lxliif
a "Jl r
:R
.� .lA,', "1�h ?II "Jri, ns'n�xJf9q '�iti ill
Plan Review
Approach / Drainage
Septic System Review
Permits:
Operator: K_C Printed By: K_C Print Date: 04/28/200:5
MAY 05 2005 15:30
509324156? PRGE.01