2003, 11-26 Permit App: BLD-03-03152 RemodelPERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688 -0036 Fax: (509)688 -0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 1 �1 O 3 S. A-vAL1 d d
ASSESSOR'S TAX PARCEL NUMBER(S): 4 S 2-2-4, 4 ) I
LEGAL DISCRIPTION: Lo 11 tG.'e-t G A4)4--%z-(
PERMIT DESCRIPTION: 4; vvis(i sqp... L44,1
UILDING PERMIT 0 CHANGE D USE C GRADING 0 MANUFACTURED HOME
RELOCATION
E SIGN E TENANT
O OTHER
OWNER / APPLICANT INFORMATION
® OWNER: ke,N ¶,• U CAiJ„� (.. /AiZJfU4C, i�j ® APPLICANT: 4 " `-(Z_
2
PHONE: 5I`1�`�ZD -i43LA FAX: ilctZ -OLIO
ADDRESS:
CONTRACTOR: W
ro
PHONE:
CITY,STATE, ZIP
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
® ARCHITECT: %l) /'4--
FAX: PHONE: 111 FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # CONTACT:
PERMIT /BUILDING INFORMATION
COST OF PROJECT: 266 "cx'D
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
1
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ FT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
HEIGHT OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
FIRE ALARM:
TENT:
DATE /TIME:
WA STATE NON - RESIDENTIAL ENERGY CODE
1
PLANS EXAMINER:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
CI BOLTING ®CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
® WELDING
FAX:
1 BUILDING STAFF USE ONLY
i
IS PUBLIC SEWER AVAILABLE:
® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES, WHICH WATER DIST /IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES ® NO
DATE:
METHOD OF PAYMENT:
CASH CHECK
STAFF:
VISA
BANKCARD i; EXPIRES: VIN #
AUTHOR /ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Spokane
.0,00Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106
Spokane Valley, WA 99206
509 - 688 -0036 - Phone
509 - 688 - 0037 - Fax
PROJECT
ADDRESS:
DESCRIPTION OF WORK
PERMIT
USE:
OWNER:
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOLIIVT
(street)
(city /state) (ZIP)
CONTRACTOR:
LICENSE #:
MAILING ADDRESS:
-
PHONE #:
2
(street)
(city /state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
8 OF UNITS
X
COST
EQUALS
AMOLIIVT
1
FUEL BURNING APPLIANCE
- OR < 100,000
X
' $15
-
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
5100
5
USED APPLIANCE (WSEC min. AFUE rating)
- or <400,000
X
950
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
$100
7
BOILER /REFRIGERATION
1 - 100M BTU
X
$15
-
8
BOILER/REFRIGERATION
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
-
15
FUEL BURNING WATER HEATER
-
X
$10
16
MISC FUEL BURNING APPL.
-
X
$10
-
17
GAS PIPING (ea. Outlet)
-
1
X
$1
18
DUCT SYSItMS
-
X
$10
=
19
VENTILATING FANS
-
X
510
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
-
X
$10
-
25
HEAT PUMP /AIR CONDITIONER
0-3 TON
X
$12
-
26
AIR CONDITIONER
3-15 TON
X
920
27
AIR CONDITIONER
15-30 TON
X
$25
-
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50 TON
X
960
30
LPG STORAGE TANK
-
X
$10
-
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
-
32
WOOD STOVE - FREE STANDING
-
X
925
VIENT
VISA. • � ,* ..
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
:THOD OF
CASH
TE:
VKCARD NUMBER:
IHORIZED SIGNATURE:
*axle
(H!
Ile
,,0,.0Vailey
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509 - 688 -0036 Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS:
DESCRIPTION
PERMIT
USE:
OWNER:
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
(city /state) (ZIP)
CONTRACTOR:
LICENSE #:
MAILING ADDRESS:
PHONE #:
2
(street)
(city /state)
(ZIP) .
PLUMBING FIXTURES
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
2
URINALS
X
$6
-
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON -SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP /CULINARY/MEAT
X
$6
6
DISHWASHER
X
$6
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
-
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN -IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND /OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
`
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
56
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
VISA M4 5c>3'- "_
°
D CHECK • ■ _.__._= . _
FXPTRFC.
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
1
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