2003, 08-13 Permit App: BLD-03-02221 ResidenceSpokane
4Viiley
4 PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
.rrs.or� "MOWN
REQUIRED SITE INFORMATION
STREET ADDRESS: 5128 N Burns
ASSESSOR'S TAX PARCEL NUMBER(S):
itb5z--f, ) 3
LEGAL DISCRIPTION: Lt 13, Blk 17 Summerfield
PERMIT DESCRIPTION:
JBUILDING PERMIT ® CHANGE IN USE ® GRADING 0 MANUFACTURED HOME® RELOCATION
SIGN CI TENANT
® OTHER
OWNER / APPLICANT INFORMATION
° OWNER: .Harley C Douglass Incril
APPLICANT:
509 487-9792 509 487-1580
PHONE: FAX PHONE:
ADDRESS: 8510 N Crestline Ste A Spokane WA ADDRESS:
CITY,STATE, ZIP 99
®2.15
CONTRACTOR:_ Harley C Douglass Inc ARCHITECT:
FAX:
CITY, STATE, ZIP
PHONE: 509 487 9792
ADDRESS: same as above
FAX: 509 487-1580 PHONE: FAX:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # H A R LEC D 110 PE
ADDRESS:
CITY, STATE, ZIP
CONTACT:
COST OF PROJECT:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 1 108
BUILDING HEIGHT TO PEAK: 35 OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
BUILDING DIMENSIONS: 28X40 CONSTRUCTION TYPE: UNFIN BASEMENT: 1040
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: 560
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
►�1�1./_1%, ll I Spokane Valley, WA 99206 509-688-0037 - Fax
•
For Inspections, call 509- 8-0054
Mechanical Permit Application
PROJECT
ADDRESS: 5128 N Burns
DESCRIPTION OF WORK
PERMIT
USE: residential construction
OWNER Harley C Douglass
X
PHONE (Dayti 5cli _9792
MAILING ADDRESS:
8510 N Crestline Ste A
Spokane, WA 99217
(street)
(city/state) (ZIP)
CO- NTRA QR: Mechanical
LICENSE 1: DANCAM102207
PHONE 8:
509 924-9921
MAILING ADDRESS:
311 N Hodges
Greenacres
WA 99016
(street)
(city/state) (ZU')
METHOD OF PA
D CASH 0 CHECK ❑ ❑ !
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
1OFUNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
X
$15
-
2
FUEL BURNING APPLIANCE
> 100,000
_
X
519
-
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- OR < 400,000
•
X
550
-
4
UNLISTED APPLIANCE (ADDfITONAL FEE)
> 400,000
X
5100
-
5
USED APPLIANCE (WSEC min. AFUE rating)
- or <403,000
_
X
550
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFRIGERATION
1 - 100M BTU
X
115
-
8
BOILER/REFRIGERATION
101 - 500M BTU
r X
528
-
9
BOILER/REFRIGERATION
501 -1,000M BTU
X
539
-
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
$57
-
11
BOILER/REFRIGERATION
+1750M BTU
X
595
' -
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
1
X
510
-
10.00
13
RANGE
--
X
510
-
14
DRYER
-
X
510 1
-
15
FUEL BURNING WATER HEATER
-
1
X
510
-
10.00
16
MISC. FUEL BURNING ADPL.
-
X
510
-
17
GAS PIPING (ea. OuIIct)
-
2
X
11
-
2.00
18
DUCT SYSTEMS
1
• X
510
-
10.00
19
VENTILATING FANS
-
X
510
-
20
AIR HANDLER (DOES NOT Include ducting)
- OR < 10,000CEM
1
X
112
-
12.00
21
AIR HANDLER (DOES NOT Include ducting)
> 10,000 CFM
X
519
-
22
EVAPORATIVE COOLERS
-
,Y,
510
-
23
TYPE I HOOD
-
X
550
-
24
TYPE II HOOD
--
X
510
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIR CONDMONER
3-15 TON
X
520
-
27
AIR CONDITIONER
15-30 TON
X
525
-
28
AIR CONDMONER
30-50 TON
X
535
29
MR CONDITIONER
+50 TON •
X
560
-
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
510
-
32
WOOD STOVE - FREE STANDING
-
X
525
-
4IEN'T
11�N� alt.
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
D CASH 0 CHECK ❑ ❑ !
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
OD OF
FI
I`3ppokane
,1 Valley
Spokane Valley, WA 99206
Dr Inspections, call 509-688— 4
509-688-0037 - Fax
Plumbing Permit Application
i
1
PROJECT
ADDRESS: 5128 N Burns
DESCRIPTION
PERMIT
USE:
Residential Construction
OWNER: Harley C Douglass Inc
COST
PHONE(DaytimeContact): 509 487-9792
MAILING ADDRESS:
8510 N Crestline Ste A
Spokane, WA 99217
TOILETS
(street)
(city/state)
•
(ZIP)
CONTRACTOR: Gold Seal Mech
12.0U
LICENs1=1:
URINALS
GOLDSM 290C4
MAILING ADDRESS:
5524_ East, Boone Spokane, WA 99212
PHONE 1:
$6
-
3
TUBS
(street)
(city/state)
X
(LIP) •
PLUMBING FIXTURES
ARD NUMBER:
RJZED SIGNATURE:
DESCRIPTION
•
DETAILS
1 OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
2
X
$6
-
12.0U
2
URINALS
X
$6
-
3
TUBS
2
X
$6
-
12.00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT•
3
X
$6
-
18.00
6
DISHWASHER
1
X
$6
-
, 6.00
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
1
X
' $6
-
6.00
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
X
$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
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
1
X
$6
-
6.00
PAYMENT
CHECK
VISA•
___ y�v�-
ig`.',6t
- -_ •-"".1
•
SUBTOTAL:
•
PLUS PROCESSING FEE:
$35.00
■
TOTAL PERMIT FEE DUE:
ARD NUMBER:
RJZED SIGNATURE:
f
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0
STA: 14+251-
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4�
16.5' R
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11-.2
13' I IDE
8:'RDER
EASEMENT
31,0
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INSTALL TYPE 1 I j
CURB INLET —
EL=2035. 6 .."-
QUEEN
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QUEEN
AVE. 0
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APPROVED B
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33 I
130.27
- 10' WIDE
EASEMENT
FOR UTILITIES
Th
LOT 14
SALE: 1 "=30'
LOT 13, BLOCK 17
I SUMMERFIELD EAST 4th ADD.
ENGINEERS SURVEYORS
1220 N. 110WARO Sr.
SPOKANE. 'W'A 68201
FAX (108) 326-6423
(506) 328-5130
101 TRAIN 60.
LEWISTON 10 13501
FAX (200) 44-6021
(206 T44-2661