2003, 06-02 Permit App: BD-03-239 Residence City of FhLx (JU0 °
SPOKANE VALLEY
PERMIT # £i) ô — 7
BUILDING PERMIT APPLICATION
Box 1 OWNER JOB LOCATION <
OWNER'S ADDRESS CITY PHONE (� 5')
DESCRIBE JOB r— t5 15 �l
JUN 0 2 2003
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED nn nn rr�� r�\�f���
PARTNERSHIP CORP. D U tl U�J
BOX 2 CONTRACTOR'S NAME C_7ru',, PHONE `?Z`Y '-`t 6 tf c F
CONTRACTOR'S ADDRESS /S3 Z ✓d1X CITY Veez1.44ie 905
CONTRACTOR'S REG.# ,>r� ' z c>320041/4, EXPIRATION DATE c 1--c.
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT .T-c, 1 PHONE 2 a 7S 6-t 5'
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ O CZ EXISTING BLDG. VALUATION $ - ---
BOX 6 PROPERTY TAX ACCOUNT NUMBER 5.50/. 24 p''
LEGAL DESCRIPTION
i Pl4C'f
Qic k
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) Lot- C8
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/ proposed) 1ST FLOOR ! 73 i/ 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
4/SY
BASEMENT UNFINISHED DECK / GARAGE= /
CARPORT / TOTAL .`. 1 / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 (.1 ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY ,•SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING/ MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
BOX 10 Water Service meter size (if known) Also see BOX 4
BOX 11 Septic Tank— Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
BOX 12 Street use may require a " Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO ` RFORM THE RK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT - DATE p` C 't (OVER)
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard ___ Expiration Date
Print the name of the Holder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
OFFICE USE ONLY- PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Received
City of PERMIT # PW O3-304
SPOKANE VALLEY
UTILITY RIGHT— OF— WAY APPLICATION AND PERMIT
PUBLIC WORKS DEPARTMENT Date project starts
Date Project ends
(Please call for final inspection)
APPLICATION
Location of property involved(or address) to /L.I S el-
Name of company `D I arnesixci `�Oc
Address of company j,3 E M i SS phone ) - 5(444
(4 4C j.
Contractors name "(-aye l' De n n i s
Contractors address phone
Contractors registration Number Expiration date
Right of Way:
Pavement or sidewalk intrusive. Yes No
Intrusive outside of pavement or sidewalks. Yes No
Length of cut ft. Depth of cut ft. Width of cut ft.
Direction of cut
Contact person
Address of contact Phone
Please explain in detail the description of the activity proposed. AnpRejae_,L
I hereby authorize the City of Spokane Valley to charge this permit fee to my charge card.
Visa mastercharge Valid Date
Print name of holder Signature
PERMIT:
Restoration: Permanent Temporary
Type of back fill to be used: gravel Crushed CDF
IS A COPY OF A BOND DEPOSITED WITH THE CITY OF SPOKANE VALLEY ?
A COPY OF THE CITY/UTILITY LIABILITY INSURANCE POLICY MUST BE ON
FILE AT THE CITY.
PERMIT FEE $ 755 ) INSPECTION FEE $
Approved
04 Pcc'. --303
Publi orks Director Date
CALL 24 HOURS BEFORE INSPECTION NEEDED
Phone 509-688-0036 Fax 509-688-0037
R-O- WAPP.
(CITY t
n 11707 E. SPRAGUE, STE 106
Valley SPOKANE VALLEY, WA 99206
(509)688-0036 FAX(509)688-0037 PROJECT TRANSMTIYAL:
TRANSMITTAL DAl'E:
SITE INFORMATION PERMIT INFORMATION
Site Address: 6 s A r,1 ;. Permit Number: Issue Date:
/`} P Permit Use:
Parcel Number: Applicant:
Subdivision:
Block: Lot: Phone:
Zoning: Water Dist: Contact:
Owner: Phone:
Address: Contractor:
Building Inspector: Setbacks—Front: Left: Right: Rear:
APPROVALS
BUILDINGS: K r4 - 3 -o-3
PLANNING: - 3 --CS
ENGINEERS: p 3 Q(4
EWER: ) `"l_
APPROVALS
WATER DIS
STO ATER:
HER:
Sei iaGie3 /4 ‘-/0-03 , i�
f-00 / "?/1, 4 G -/e-03 f'`` >%�
1;7u/1161/(2°"-\ 4- 6-/-2 -c1-3 7< s-)7;‹,
sad 344 /..,4 / 6 -0- a3
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r
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ga 5 p ;/, e- 4 5,c,--c., 3 7< //7),e__
4 17-4--..C--- 4--- s'-- V- 5 ic >?7;/ -if---
rnt,lane
11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
Spokane Spokane Valley,WA 99206 509-688-0037-Fax
,,,,,•*Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: / ' ./ 5 USE: S
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
.nom r,..cs S Ze_3 i:k
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP) • .
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 C/
2 URINALS S
X $6
3 TUBS -
X $6 •
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 10
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- J X $6
RAY,FOOD,PREP/CULINARY/MEAT j�A� 42,/
6 DISHWASHER 7
7 CLOTHES WASHER
r X $6
8 GARBAGE DISPOSAL t X $6 °
X $6
9 WATER SOI'I bNER •
X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X
11 FLOOR DRAINS °
AREA,CASE,COIL,TRENCH,CONDENSATE X $6 - «
12 FOUNTAINS,DRINKING
-
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, X $6
WASTE,VENT,PLUMBING REVERSALS
REVERSAL X $6 -
14 SEWAGE EJECTOR GRINDER,SUMP PUMP
15 WATER USING DEVICE X $6
ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6
SWAMP COOLER °
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 °
17 SPRINKLER SYSTEM
18 INTERCEPTORS X $25 -
GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6
19 MEDICAL GAS per outlet NITROUS,OXYGEN
20 MISC.PLUMBING FIXTURE X $6 °
X $6 °
sTHOD OF PAYMENT SUBTOTAL: f CO
CASH ❑ CHECK ❑ °'.%; PLUS PROCESSING FEE:
❑ ._._._._°_-..._ 35+99--
TOTAL PERMIT FEE DUE:
' EXPIRES:
JKCARD NUMBER:
HORIZED SIGNATURE:
StTTI I I�r 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
j li. ne Spokane Valley,WA 99206 509-688-0037-Fax
all For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 4/11 Siy r�P c USE:
OWNER PHONE(Daytime Contact): C 2 i., 1 6 y
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: -1�-.'rGi 7 "')a�c�Z LICENSE#: Qlet 4.4 3 !�
MAILING ADDRESS: PHONE It: ZY v; `f �Y
Ve i--r-lec, ( vv4 6'i
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE _•OR<100,000 t X $15 - I S
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 ' X $50 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 -
5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X $50 =
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 -
7 BOILER/REFRIGERATION 11pgk4 BTU X i $15 , -
8 BOOLER RIDER:\1'1C*i 101-500M BTU X $28 -
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 =
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95 -
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 =
13 RANGE -- X $10 =
14 DRYER - X $10 = h.i
15 FUEL BURNING WATER HEATER -- I X $10 = % C
16 MISC.FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - = X $1 - 3
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - 4/ X $10 = 41 L
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 •
22 EVAPORATIVE COOLERS - X $10 =
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - 1 X $10 = r
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 -
26 AIR CONDITIONER 3-15 TON X $20
27 AIR CONDITIONER 15-30 TON X $25 -
28 AIR CONDITIONER 30-50 TON X $35
29 AIR CONDITIONER +50 TON X $60 =
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X $10 -
32 WOOD STOVE-FREE STANDING - X $25 -
= SUBTOTAL: — f t v`
METHOD OF PAYMENT PLUS PROCESSING FEE: +,P�8,88-
VISA t.41-nr,;:-
TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK ❑ MOM ❑ : _,
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: ,