2004, 04-21 Permit App: BLD-04-04163 Addition00,\,3/4
*lane
,valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: ,2 SSV , A s ie._
Assessor's Tax Parcel Number(s): '3i7%', c(6/ 2 4"
Legal Description: j�
PERMIT DESCRIPTION: S5OD . ft All7-8/7
'Building Permit ❑ Change in Use ❑ Grading C Manufactured Home
[I Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:0h /VLy% AXaii
Phone: 9Zy--/ yy Fax:
Address: �J-OY S. &4 15 Xe,
5;20
Qty A✓l kis State
/� Zip Code
111Contractor: 1 / ,4' cc &Di T6 Ca
Phone:
Ad
State Zip Code
❑ Applicant:
Phone:
Address:
Fax:
City
❑ Architect:
Phone: Fax:
Address:
State Zip Code
City -
WA State Contractor License #: kAV%7CCIO 6/ Contact .
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: J� /"
DIMENSIONS:7°
# OF STORIES:
MAIN FLOOR Q. FTG
4
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENt SQ. FTG:
el -41v 7
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCEC90S
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER ORO -SITE SEPTIC
SYSTEM? * xz-
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Fireworks Display: Blasting:
Paint Booth:
DaterTime:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:.
Inspector(s):
Fax:
❑ 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 development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
*lane
4,Valley
Project Address:
M ✓
Owner: (;Kole t
Mailing Address:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
C7,City State Zip Code
Contractor: 4/ License #: Phone #:
Mailing Address:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET BIDETS
/
X
$8.00
=
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
16.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,/
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
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
16.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
16 00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
' REPAIR, REVERSALS
X
16.00
=
15
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
18.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
16.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
$8.00
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
16.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
135.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
S kkan e�
jvalley
025.0 5 cl“) fr
Project Address;
Owner:
Mailing Address: .
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use: 71;0,--t
Contractor:
Mailing Addr-ss:
Phone (Daytime Contact):
f Licens #: /' U91 1‘<i /&, P one #:State 71.4
/9Zyip Code
h.
State
City State Zip Code
AUTHORIZED SIGNATURE: .��/l(et-GQ
DESCRIPTION OF WORK
# OF
UNITS
X
COST
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100 000
X
$15.00
=
2
FUEL BURNING APPLIANCE
More than 100 000
X
$19.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400 000
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or fess 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
$15.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 -1 000M BTU
X
$39.00
=
10
BOILER/REFRIGERATION
1,001 -1 750M BTU
X
$57.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
510.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
X
$10.00
=-
18
18
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
510,00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10 000 CFM
X
$19.00
=
22
EVAPORATIVE COOLERS
X
510.00
=
23
TYPE 1 HOOD
X
$50.00
=
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
=
28
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
$25.00
=
METHOD OF PAYMENT:
IDCASH 0 CHECK 0 VISA CIMC
CARD#: �i-
DATE:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
MBEs. .
AUTHORIZED SIGNATURE: .��/l(et-GQ
soy 5. d3 tef l�c
ILIZZ. 49 147;1_
Kt)O
�nr
This site plan is being submkbd for the
obtaining a building permit and is a true and
representation of the proposal. MI knoUn
lines/dimensions; curb tines. stru0/Ylaa Med
have been identified. Also indiaMed
bodies of w
Signed:
Date:
tiyob!
My .$ 8n /'S
ADORE88 - 1
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ROAD o
FRONT 4
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