HomeMy WebLinkAbout2004, 03-03 Permit: App: BLD-04-03663 Reroof, SidingSame
Spokane
Valley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
4 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:
Ca? -
,S 61 t4 --ice. (S f,i<tr.Z
Assessor's Tax Parcel Number(s):
Legal Description: nn ^n
PER Roc- UGh-Lb j i '5 I td 105 Lt L 4%o�'U) S
❑T Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation (1 Tenant Improvement ❑ Fire Safety
❑ Other
OWNER/APPLICANT INFORMATION
Owner: 77)!(17°
Phone: 9ot5- -‘,7C�v Fax:
Address:
Applicant:
Phone:
Address:
Fax:
City State Zip Code City
❑ Contractor: Qr-ki\ ( b4'pt41uc c Irk—c— ❑ Architect:
Phone: 994-3(1 3k Fax: g,)D Phone: Fax:
Address: /j 3a .3 t 0/SLtvLI iMiL,q- Address:
IrfA),,-( \VA cc 2-050
CitV State Zip Code
State Zip Code
City
State Zip Code
WA State Contractor License #: O r4l e3 M R I at tM cContact: 0 n0 — 9 ) 9 —103c7
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COSJ OF PROJECT: icy
�� aj 000`/
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
Bankcard #:
Authorized Signature:
Er-Cleck
❑ Mastercard
0 VISA
Expires:
VIN#:
❑ Other
Same
Wiley
Project Address: Co? {—S I61 vi-tce-
Owner "Th MS/ 4 k Ski
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):
Contractor: 1) A-4 e,.. tN 1 nm -e_ l License
(I 3? , ,OCS tGfd rt -w
Mailing Address:
City State Zip Code
#: its llJ/l/ali/C(Phone #: 9 2 Y-3er-36'
(NC Sa(C,anrc
City
Ge -/b
State
SCPO (O
Zip Code
BANKCARD NUMBER'
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
56.00
=
2
URINALS
X
56.00
=
3
TUBS
a
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
6
DISHWASHER
1
X
$6 00
7
CLOTHES WASHER
X
$6 00
=
8
GARBAGE DISPOSAL
X
56.00
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
1
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
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
56.00
=
20
MISCELLANEOUS PLUMBING F URE
X
$6.00
=
METHOD OF PAYMENT:
❑ CASH CHECK 0 VISA 0 MASTERCARD
DATE: • EXPIRES:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER'
AUTHORIZED SIGNATURE: