2003, 08-11 Permit App: BLD-03-02226 AdditionCity of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER 12\ ilk V\ JOB LOCATION CI $ /V, 6434 Ra(
OWNERS ADDRESS Svos"u 81,4 4.( CITY Spoknvie PHONE 5179. 91v -/TP -3
DESCRIBE JOB {'d h;goo Ct6A/P 4cinnt
V J
THIS PROPERTY IS OWNED BY: SINGL /(MARRIE
CORP.
PARTNERSH
BOX2 CONTRACTORS NAME g sly - Nome- g - (pg Itvaevi P
CONTRACTOR'S ADDRESS S-908 /U 6-654 td
ONE 509- 3112-15/S
CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED)
BOX 3 CONTACT PERSON OF PROJECT i{ny R, (V\ PHONE 509- 3t2.-ir/r
ADDRESS -CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $ 3C) 00 0 EXISTING BLDG. VALUATION $ /5-0; GO O
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existingpropose 1ST FLOOR
FLOOR /
3RD FLOOR / BASEMENT
GARAGE / CARPORT
/ /OSP 2ND
/ DECK /
/ TOTAL /
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY SQ. FT.
IMPERVIOUS SURFACE_ SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough -ins)
NO. Z WATER CLOSETS - URINAL
BATHTUBS - FAUCETS
PRIVATE SEWER SYSTEM
/ SHOWERS
Z LAVATORIES
SINKS
DISHWASHERS
ELECTRIC HOT WATER HEATER
LAUNDRY WASHER OUTLET
LAWN SPRINKLER SYSTEM
DRINKING FOUNTAINS
SUMPS, SPRINKLER VACUUM BREAKERS
FLOOR DRAINS
BACKFLOW PREVENTER
VACUUM TYPE BREAKER
HOT TUBS
S TOTAL FIXTURES
MECHANICAL APPLIANCES
GAS PIPING : OUTLETS
NO. FURNACE, ELECTRIC
(BTU RATING
GAS HOT WATER HEATER
CONVERSION BURNER
BOILER: SIZE
AIR HANDLING UNITS
HEAT PUMPS: SIZE
GAS
UNIT HEATERS
AIR COOLING UNITS; SIZE
_ COMMERCIAL HOOD
GAS APPLIANCES
FIREPLACE INSERTS
EXHAUST VENT FANS
APPLIANCE VENT REPAIR
WOOD STOVE SYSTEM
2 TOTAL UNITS
OVER
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 PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT
DATE /( 03
I hereby authorize th • City of Spokar(e 'alley to charge the fee for this permit to my credit card:
Visa Mastercard Expiration Date
Print the name of the Holder Signature
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
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
ASSIGNED ADDRESS
METHOD OF
0 CASH
DATE:
Spokane
PValley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT 5-70e-
, (� ¢ n/
ADDRESS: / / c' N. 8Q� iZ
DESCRIPTION
PERMIT
USE:
OWNER /4/ /,'1a�/ in
X
COST
PHONE (Daytime Contact): 3Y,2- /f/s—
MAILING ADDRESS:
51/0 t AL 8e5 P1
SfQtarp
W xi
WATER CLOSET, BIDETS
9Y ./4
(street)
(city/state)
-
• (ZIP)
2
CONTRACTOR:
LICENSE #:
$6
-
MAILING ADDRESS:
3
TUBS
PHONE #:
X
S6
-
(street)
(city/state)
BATH, STALL, ON-SITE BUILT
(ZIP)
X
PLUMBING FIXTURES
EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
Z
X
$6
-
AA -
2
URINALS
X
$6
-
3
TUBS
X
S6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6
-
6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
n/
h
X
$6
-
/2
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
S6
-
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
$b
- -
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
E6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
❑ CHECK
anials
<:
Ns _ . •:;
_._.__.""_
SUBTOTAL:
3O i
PLUS PROCESSING FEE:
$35.00
• UM= ■
TOTAL PERMIT FEE DUE:
EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
Sfio'kanka� ems'`
#Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS:
PERMIT
USE:
OWNER
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
(city/state) (ZIP)
CONTRACTOR:
LICENSE 1:
MAILING ADDRESS: - . -
-
PHONE t:
2
(street)
(city/state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
A OF UMTS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
X
515
-
2
FUEL BURNING APPLIANCE
> 100,000
X
519
•
3
UNLISTED APPLIANCE(ADDTRONAL FEE)
•OR<400,000
X
550
•
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
5100
-
5
USED APPLIANCE (WSEC min. AFUE rating)
- or c 480,000
X
550
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515
-
8
BOILER/REFRIGERATION
101- 503M BTU
X
528
-
9
BOILER/REFRIGERATION
501- 1,000M BTU
X
539
-
10
BOILER/REFRIGERATION
1001- L750M BTU
X
557
•
11
BOILER/REFRIGERATION
+1750M BTU
X
595
•
12
CAS LOG, GAS INSERT, GAS FIREPLACE
-
X
510
-
13
RANGE
-
X
510
-
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
X
510
•
16
MISC FUEL BURNING APPL.
-
X
510
-
17
GAS PIPING (ea. Outlet)
-
X
51
-
18
DUCT SYSTEMS
-
X
510
•IV
^
19
VENTILATING FANS
-
X
510
•
-20
20
AIR HANDLER (DOES NOT include ducting)
• OR < I0,000CFM
X
512
-
21
AIR HANDLER (DOES NOTindudeducting)
>10,000 CFM
X
519
•
22
EVAPORATIVE COOLERS
-
X
510
-
23
TYPE IHOOD
-
X
550
-
24
TYPE R HOOD
-
X
510
•
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
•
26
AIR CONDITIONER
3-15 TON
X
-520
•
27
AIR CONDITIONER
15-30 TON
X
525
-
28
AIRCONDIIIONER
30-50 TON
X
535
29
AIR CONDITIONER
+S0 TON
X
560
-
30
LPC STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
. 510
-
32
WOOD STOVE - FREE STANDING
-
X
525
-
HENT
Y/SA'
.-.. n 4mmenn n
"rrs
!Virzi-
�ti',b•�1
SUBTOTAL:
PLUS PROCESSING PEE
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
144
/00
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