2005, 03-25 Permit App: 05000950 Finish BasementProj get Number: 05000950 Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/25/2005 Page 1 of 2
Project Information:
Permit Use: FINISH BASEMENT - (2) BEDROOMS, OFFICE,
FAMILY ROOM & BATH/LAUNDRY
Setbacks: Front Left:
Site Information:
Plat Key: 006306
Right: Rear:
Contact:
Address:
C - S - Z:
Phone:
Group Name:
Project Name:
GOTISHAN, NIKOLAY
5128 N BURNS RD
SPOKANE VALLEY, WA 99216
(509) 924-0287
Name: SUMMERFIELD EAST 04TH ADD District: Nort
Parcel Number: 46354.9050
SiteAddress: 5128 N BURNS RD
Location:: CSV
Block: 17
Zoning: UR -3.5 Urban Residential 3.5
Water District: 001 TRENTWOOD
Area: ,343.00 Acres Width: 82
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Permits:
Contractor: OWNER
Lot: 13
Owner: Name:
Address:
GOTISHAN, NIKOLAY
5128 N BURNS RD
SPOKANE VALLEY, WA 99216
Hold: ❑
Depth: 130 Right Of Way (ft): 38
Building Permit
Firm: OWNER
Phone: (000) 000-0000
This Application:
Description Grp Type Notes Sq Ft
BASEMENT R R-3 VB 1,040
Totals: 1,040
Valuation
$5,200.00
Total Project:
Sq Ft Valuation
1,040 $5,200.00
Item Description Units Unit Desc
RESIDENTIAL PERMIT FEE 1 SELECT
STATE SURCHARGE 1 SELECT
RESIDENTIAL PLAN REVIEW 1 SELECT
Contractor: OWNER
Item Description
VENTILATING FANS
$5,200.00
Permit Total Fees:
Mechanical Permit
Firm: OWNER
Phone: (000) 000-0000
1,040 $5,200.00
Fee Amount
$125.25
$4.50
$50.10
$179.85
Units Unit Desc
1 NUMBER OF
Operator: K_C Printed By: MT
Permit Total Fees:
Print Date:
Fee Amount
$10.00
$10.00
03/25/2005
Project Number: 05000950
Inv: 1
Application
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Date: 03/25/2005
Contractor: OWNER
Item Description
TOILETSBIDETS
SINKS
TUBS
Notes:
Payment Summary:
Permit Type
Building Permit
Mechanical Permit
Plumbing Permit
Plumbing Permit
Page 2 of 2
Firm: OWNER
Phone: (000) 000-0000
Units Unit Desc
1 NUMBER OF
1 NUMBER OF
1 NUMBER OF
Fee Amount
$179.85
$10.00
$18.00
Permit Total Fees:
Invoice Amount
$179.85
$10.00
$18.00
Fee Amount
$6.00
$6.00
$6.00
Amount Paid
$0.00
$0.00
$0.00
$18.00
Amount Owing
$179.85
$10.00
$18.00
$207.85 $207.85
$0.00
$207.85
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: MT
Print Date: 03/25/2005
Spouliane
4,0017alley
•
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
MAR 23 2065
11707 E. Sprague A venue, Suite 106
i Spokane Valley, WA 99206
one: (509) 688-0036; Fax: (509) 688-0037
IRMATION
Street Address: 171A1 1_` 122 ucKitn 2i ,Cj�QjCcA , UtI(Pj WA 994/b
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit
❑ Relocation
n Change in Use I 1 Grading ❑ Manufactured Home
n Tenant Improvement n Fire Safety n Other
OWNER/APPLICANT INFORMATION
A
Owner: 9 of
Phone: -v. , 7`'=ax: '. -0: 27
Adress: Lvi2Avie,
n
Contractor:
Phone:
Address:
Fax:
City
State Zip Code
WA State Contractor License #:
❑ Applicant: j �� C044e1
Phone:' ; -0,9, , - Fax: gob./
Fl
Address: / ?)Lt -62
City tate Zip Code
Architect:
Phone:
Address:
Fax:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR.TO SQ. FTG: .
.2"1". 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: OC..,
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? SQA ��
PLUMBING PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
ProjectAdcress: :31(At
Owner: N 11X°) Citi'- GC%47cSS v
Mailing Address: 570R
Contractor:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact):(5) L/ — v
„Sri . t /a// y ji- 9'19 6
Ci ate Zip Code
License #: Phone #:
Mailing Address:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
. COST •
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS'
1
X
' $6.00
=
2
URINALS
X
$6.00
=
3
TUBS
1
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
•
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
1
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
.j
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
56.00
=
12
%ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE, 1
VENT, PLUMBING, REVERSAL
NSTALIATION, ALTERATION, REPAIR,
• REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
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
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00 '
_
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
21
PRIVATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
•
METHOD OF PAYMENT:
CASH '❑ CHECK 0 VISA 0 MASTERCARD
DATE: 0 °-) \
- A')) 05 EXPIRES:
SUBTOTAL
PROCESSING FEE
. 535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Project Ad , ess:
Owner:
Mailing • ddress:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, �Call
(509) 688-0054 a Oak() ak() Permit Use:
Community Development Depertmen
Building Divisior
11707 E. Sprague Avenue, Suite 10E
Spokane Valley, WA 9920E
((Phone (Day$ nfact):
Cit
Contractor: License #:
Mailing Address:
c
State
Zip Code
Phone #:
State
Zip Code
HORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$t2.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00
=
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
535.00
=
'
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
=
17
GAS PIPING (each outlet)
X
$1.00
=
18
DUCT SYSTEMS
X
$10.00
=
19
VENTILATING FANS
/
X
$10.00
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM .
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$15.00
=
22
EVAPORATIVE COOLERS
X
510.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE 11 HOOD
X
$10.00
=
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
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
=
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
=
METHODETOF PAYMENT:
LJ CASH fl CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
HORIZED SIGNATURE:
NtS
SS REDOIREME �,..
�M�RGFROM SLEEPING R°°MSSpUARE FEEL
FROM 5A SpUARE
NEt GLOB OPENINGOPENING!441
,0 SOIJ E S
1 FLOOR OPENING 20 %CV FLOOR
GF El C E R OPENING 44" ASOS�EOF /
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