2003, 04-24 Permit App: BD03-183 DuplexCity of
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER
OWNER'S ADDRESS CITY PHONE
JOB LOCATION c r/ N C 4=--h C
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME C 3'/ PHONE 9 Zf 5,r9 6`/
CONTRACTOR'S ADDRESS /C .S'2. t ,r_ A CITY c/c. .ir it- •4ic
CONTRACTOR'S REG.# SZcr4i EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT . ►1 PHONE z /
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY Al O WATER AVAILABILITY L.icfrt. So rd 4
BOX 5 ESTIMATED PROJECT COST $ 2 /- EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER ,5J'/6-oQ. 25 U.'�
LEGAL DESCRIPTION S p 94
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed)
3RD FLOOR / OTHER
BASEMENT UNFINISHED / DECK
CARPORT / TOTAL /
1ST FLOOR /,-9( - 2ND FLOOR —7-
BASEMENT
YBASEMENT FINISHED ✓` erl) /�
/ GARAGE i,e7'sr-
HEIGHT TO PEAK OF BUILDING
FT.
BOX 8 ( ) SINGLE FAMILY
(L 1 ULTIFAMILY (NO. OF UNITS Z )
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY ?J O ESQ. FT.
IMPERVIOUS SURFACE 23 ; 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 UMTS, 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 PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
f4
OWNER / AGENT 12 -off DATE ` 21- 3 (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
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 COMMERCIAL
MULTIFAMILY ADD/ALT TENANT IMP.
OCCUPANCY /71
\
COMM. ALT/ADD
NEW INDUSTRIAL IND. ADD/ALT
NEW MULTIFAMILY NO. UNITS
ROOF OTHER
TYPE OF CONSTRUCTION 4,1;"4 44.it-e- 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
Sfiiikane
�,,.�Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: c 1 r /'J Ce.e- & q& -e -USE:
PERMIT
OWNER:
X
COST
PHONE (Daytime Contact):
MAILING ADDRESS:
1
FUEL BURNING APPLIANCE
- OR < 100,000
(street)
X
(city/state)
(ZIP)
CONTRACTOR: Dir4"c4
f)J'dLk—.
FUEL BURNING APPLIANCE
LICENSE It:
n
r q -t yr c.,-.,, .3 ZC, U
MAILING ADDRESS:
919
-
PHONE It:
q 2 v6 y
UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR < 400,000
(street)
X
(city/state)
(ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR < 100,000
Z.
X
$15
-
30
2
FUEL BURNING APPLIANCE
> 100,000
X
919
-
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
9100
-
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
-
-Zjj
13
RANGE
-
X
$10
=
14
DRYER
-
Z
x
sio
Z o
15
FUEL BURNING WATER HEATER
--
Z
X
$10
=
2-0
16
MISC. FUEL BURNING APPL.
-
X
$10
=
17
GAS PIPING (ea. Outlet)
-
l
X
$1
-
14
18
DUCT SYSTEMS
-
2
X
910
=
2-C)
19
VENTILATING FANS
-
A
X
$10
=
LAG,
20
AIR HANDLER (DOES NOT include ducting)
= OR < 10,000CFM
X
912
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
-
Z.
X
$10
=
zo
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
935
-
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
925
=
VIENT
MOM_. ,
•
—
-
SUBTOTAL:
PLUS PROCESSING FEE:
,$35:00
-
TOTAL PERMIT FEE DUE:VISA )CI / i OL
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
METHOD 0
0 CASH
DATE:
f1T1' c�'
jlokane
,,,►Walley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT //
ADDRESS: e 1 N (11,;4 t.-4 l •t . le
PERMIT
USE: fiI /72
DETAILS
# OF UNITS
OWNER:
PHONE (Daytime Contact):
AMOUNT
MAILING ADDRESS:
TOILETS
WATER CLOSET, BIDETS
i�
X
(street)
(city/state)
(ZIP)
2
URINALS
CONTRACTOR:
/
LICENSE #: '
$6
_
co
MAILING ADDRESS:
5 3 z i
e �ss to -Alm-
\(t(<_. Y -A
PHONE #:
`�2 H�
6�
$6
ei 037
4
SHOWERS (PER TRAP)
(street)
(city/state)
(ZIP)
$6
PLUMBING FIXTURES
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
i�
X
$6
=
?.1-\
2
URINALS
/
X
$6
_
3
TUBS
X
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
`�l.\
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
%
C
X
$6
=
3 _ i..e
6
DISHWASHER
X
$6
=
Q-
1Q-
7
7
CLOTHES WASHER
Z
X
$6
=
l Q
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
'Z
X
$6
-
' -2-
Z12
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
=
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
2.-
X
$6
=
-
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
$6
=
20
MISC. PLUMBING FIXTURE
X
$6
=
PAYMENT
] CHECK
VIS.4
_.
Ins
:_._.__--_-_- . _
SUBTOTAL:
PLUS PROCESSING FEErIf$35:00-`—
■ OR= •
TOTAL PERMIT FEE DUE:
f31L0
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
rc muiLll1NU & CODE ENFOR 4 99249728
NO.50B
D002
Qr.;_
N89.57'37'W
N- 25' BUILDING SETBACK
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NT
/ 35' _ Q
— 1 Rad. 50.00'
Leng. 56.21'
Delta 65'05'44'
S6S•de U Chord 5190' 9
20,928 SQ. FT.
811 NORTH
DRYWELL
TYPE 'A'
6' OFF PAVEMENT
TRACT B, BLOCK 43
SP -941--93
EXPIRES 06/27/00
04/18/03 FRI 08:46 (TX/RX NO 5610)