2012, 04-23 Permit App: BLD-2012-0459 Residence•
P 1111'1 Center
11707 E Sprague Ave, Suite 100
Spokane Valley, WA 99206
Valley (509)688-0036 FAX: (509)088-0037
Community Development www.spol:a nuvallcy.org._com
Residential Construction
Permit Application
LD- zeta- O4
PERMIT NUMBER:
PERMIT FEE:
A New Construction
o Addition/Remodel
D Other:
o Accessory Bldg
o Deck
SITE ADDRESS Do . IMO Coo. c
ASSESSORS PARCEL NO: LEGAL DESCRIPTION: 4rdove, L.011.5
Building,oWner
Name: Di a v40Aot Rix k Coy'
Address:
City:
Zip:
Phone:
Fax:
CcinfUetTOritini-".y
Name: Pau
Phone: 2yri -Li
Describe the scope of work in detail:
guild c.. ,'.0 SFP
Contractor
Name: ' Zoe. K Coil si:
Address: Z(, OZ. M. St, )1 iii4 il led
City: 5(20,texite VA11ey Zip: 991 1 to
yhc-jtic_,t--LF2zsLjtj:-
Lie No: Exp. Date:
City Business Lie No:
Cost of Project:
************** m lete: (write N/A if not a licable **********************
HEIGHT TO PEAK: i
DIMENSIONS:i
211X5C;
OF STORIES:
2
TOTAL HABITABLE SPACE:
t3iz
MAIN FLOOR TO SQ.
FTG:AREA-
(07Z-
2Nu FLOOR SQ. FTG:
Cp410
UNFIN BASEMENT SQ. FTG:
&
IMPERVIOUS SURFACE
. NIr'
FINISHED BASEMENT
SQ. FTG: -€9,-
GARAGE SQ. FTG:
Li 440
DECK/COV. PATIO SQ. FTG:
ico
30% SLOPES ON
PROPERTY: N I A
# OF BEDROOMS:
Z
CONSTRUCTION TYPE:
Wood F. -mow
HEAT SOURCE:
Notfurril Gas Ate 'la Lt
SEWER OR SEPTIC?
stwei-
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. 6) Plans or additional information may be required to be submitted, and subsequently approved before
this application can be processed.
Signature
I NI
Date
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
Lil Cash D Check 0 Mastercard 0 VISA
Bankcard #: Expires: VIN#:
Authorized Signature:
REVISED 812512005
0 Other
pcjk ne
. Va 1 ley
Community Development
Permit ('enter
1 1707 E Sprague Ave, Suilc 106
Spokane Valley, WA 99206
(509)688-0036 FAX: (509)688-0037
www.spokann alley.orrl Crum
Mechanical Permit Application ❑ Commercial
SITE ADDRESS
2011 N• Cold I - oiz
PERMIT NUMBER:
PERMIT FEE:
y Residential
Building owner
Name: 12)j'G,,A0 4 206 K
Ca as t
Phone:
lig-1 k6 K
City
Fax
State
Zip
Address:
Contractor
Name: Sl p ka. At. t{{q {"
.' (co 14'141
.J
Phone:
City
Fax:
State
Zip
Address:
License No.
City Business License No:
Contact
Name:
Phone:
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
l
x
$12.00
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
1Z
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
$100.00
5
USED APPLIANCE (WSEC min. AFUE rating)
Equal to or less 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
$12.00
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$25.00
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
13
RANGE
X
$10.00
14
DRYER
X
$10.00
15
FUEL BURNING WATER HEATER
X
$10.00
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
1
0
10
17
GAS PIPING (each outlet)
2
X
$1.00
2
18
DUCT SYSTEMS
x
$10.00
ID
19
VENTILATING FANS
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
4
X
X
$10.00
$12.00
'iv
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
22
EVAPORATIVE COOLERS
X
$10.00
23
TYPE I HOOD
X
$50.00
24
TYPE II HOOD
X
$10.00
IU
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
26
AIR CONDITIONER
3-15 TON
X
$20.00
27
AIR CONDITIONER
15-30 TON
X
$25.00
28
AIR CONDITIONER
30-50 TON
X
$35.00
29
AIR CONDITIONER
More than 50 TON
X
$60.00
30
LPG STORAGE TANK
X
$10.00
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
32
WOOD STOVE - FREE STANDING
X
$25.00
33
REPAIR & ADDITIONS
X
$15.00
34
VENTILATION SYSTEMS
X
$12.00
35
VENTILATION MECHANICAL EXHAUST
X
$12.00
36
INCINERATOR - RESIDENCE
X
$19.00
37
INCINERATOR - COMMERCIAL
X
$22.00
METHOD OF PAYMENT:
❑CASH ❑ CHECK ❑ VISA ❑ MC
CARD #
AUTHORIZED SIGNATURE:
DATE.
EXPIRES -
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
REVISED 8126/05
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PLANNING DEPT. APPROVED
BY:
DATE:
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