2003, 08-14 Permit App: BLD-03-02235 ResidencePERMIT APPLICATION WORK SHEET
►�i SPOKANE VALLEY COMMUNITY DEVELOPMENT
,„ S BUILDING DIVISION
i O
11707 East Sprague Ave Ste 906
1' # Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
5206 N Burns
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):__ ,
S71
LEGAL DISCRIPTION: Lt 12, Blk 17 Summerfield
PERMIT DESCRIPTION:
elBUILDING PERMIT
n RI.LOCA'i'ION
residential construction
® CHANGE IN IESE fl GRADING ® IVIANUFACTURI?;1) IIOMI
DISIGN IDTENANT ®O'I'l1ER
OWNER / APPLICANT INFORMATION
OWNER: APPLICANT:
Harley C Douglass Inc
PHONE: 509 487-9792 FAX. 509 487-1580 PHONE:
FAX:
ADDRESS:8510 N Crestline Ste A Spokane WA ADDRESS:
CITY,STATE, ZIP
CONTRACTOR:Harley C Douglass Inc 99Y--1
92 ARCHITECT:
PHONE: 509 487 9792 FAX: 509 487-1580 PHONE: FAX:
ADDRESS: same as above
CITY, STATE, ZIP
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # HA RLECD 110PE
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: 35
BUILDING DIMENSIONS: 28X40
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGI IT SETBACK:
3
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 1108
OCCUPANCY GROUP: 2N0 FLOOR SQ FT:
CONSTRUCTION TYPE: UNFIN BASEMENT: 1040
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE: 560
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
) OF
N)okane
•,r,,..Vll ley
1
Spok -e Valley, WA 99206
�,"i UVV-IIUJV - 1 1111111_
"09-688-0037 - Fax
r Inspections, call 509-688—OL 1
Plumbing Permit Application
PROJECT 5206 N Burns
ADDRESS:
DESCRIPTION
PERMIT
USE: Residential Construction
OWNER: Harley C Douglass Inc
X
PHONE (Daytime Contact): 509 1187-9792
MAILING ADDRESS:
8510 N Crestline Ste A Spokane,
WA 99217
1
(street) (city/state)
•
(ZIP)
CONTRACTOR:, Gold Seal Mech
$6
LICENSE /:
GOLDSM 290C4
MAILING ADDRESS:
5524_ East, Boone Spokane, WA
99212
PHONE t':
X
$6
(street) (city/state)
(ZIP) '
PLUMBING FIXTURES
ID NUMBER:
ZED SIGNATURE:
DESCRIPTION
DETAILS
1 OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
2
X
$6
-
12-.00
2
URINALS
X
$6
-
3
"TUBS
2
X
$6
-
12.00
4
5
SIiOWERS(PER TRAP)
BATT I, STALL, ON-SITE BURT
X
$6
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
3
X
$6
-
•
18.00
. 6.06
6
DISIIWASIIER
1
X
$6
-
7
CLOTHES 1VASIIER
X '
$6
-
8
9
GARBAGE DISPOSAL
X
$6
-
WATER SOFTENER
X
$6
-
10
ELECT. IIOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
-
11
12
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
1
X
' *6
-
6.00
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
SWAMP
AND/OR COFFEE MAKER, HOSE B[B,
STEAMER, PROOFER, CARBONATOR,
COOLER
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CIIECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS GREASE
HOLDING
TRAP, SAND TRAP, CI IEMICAL
TANK
X
$6
-
19
MEDICAL GAS per outlet NITROUS,
OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
1
X
$6
-
6.00
PAYMENT
CHECK
iiiiimi141�5t.
_
SUBTOTAL.:
PLUS PROCESSING FEE:
$35.00
❑ ■
TOTAL PERMIT FEE DUE:
ID NUMBER:
ZED SIGNATURE:
iIJ0Ji.L1 1C
Valley
Mechanical Permit Application '
t)ol.aite Valley, WA 99206
For Inspections, call 509—e j-0054
00.)t) -1'11(nie
509-688 0037 - Fax
1
pROJECI
ADDRESS: 5206 N Burns
DESCRIPTIOI'J0PW�RK
PERMIT residential
USE: construction
c""ER: Harley C Douglass
X
P"°NE (DaY"ill9792
tW
IselAll INC; ADDRESS:
8510 N Crestline Ste A
Spokane, WA 99217
(city/state) (ZAP)
(street)
cc)NTRAcr
ffincar Mechanical
- OR < 100,000
LICENSE 1:
DANCAM102207
PHONE 1;
509 924-9921
MAILING ADDRESS:
•
311 N Hodges
$15
Greenacres WA 99016
(street)
(city/state) (ZIP)
METHOD OF PAY
CASH El CI
DAIE:
BANKCARD NUMBER:
Alfri IORIZED SIGNAUIRE:
EXPIRES:
DESCRIPTIOI'J0PW�RK
8 OF UNITS
X
COST
EQUALS
ilel 01INT
1
FUEL BURNING APPLIANCE
- OR < 100,000
X
$15
.
2
FUEL BURNING APPLIANCE
> 100,1330
X
5i9
.
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- Oft < 400,000
X
550
..
I
UNLISTED APPLIANCE (ADDMONAL FEE)
> 400,000
X
5100
• .
5
USED APPLIANCE (WSEC mln. AFUE rating)
- or <400,000
X
550
.
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
.
7
BOILER/REFRIGERAT1ON
1 - 100M BTU
X
525
-
8
BOILER/REFRIGERATION
101 • 500M BTU
'X
$28
-
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39
-
10
BOR.ER/REFRIGRRATION
1001 - 1,750M BTU
X
$57
.
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
12
GAS LOG, CAS INSERT, GAS F3RELACE
-
I
X
510
-
10.00
13
RANGE
X
910
..
14
DRYER
-
X
910
..
15
FUEL BURNING WATER !MATER
-
1
X
$10
-,
10.00
16
M1SC FUEL BURNING AT .
-
X
910
-
17
GAS PIPING (ea. Outlet}
2
X
51
-
2-00
18
DUCT SYSTEMS
-
1
. X
510
-
10.00
19
VENTILATING FANS
-
X
$10
-
•
20
AIR HAND ES NOT Include du n
-OR<1O,000CFM
1
X
512
-
12.00
21
AIR HANDLER (DOES NOT Include ducting)
> 10,000 CFM
X
$19
-
22
EVAPORATIVE COOLERS
-
X
910
.
23
TYPE 11100D
X
$50
-
24
IYPE 1118000
-
X
910
-
2
EAT PU P COND ONER
TON
X
$12
•
26
AIR COND ONER
3-151014X
2
-
27
AIR CONDITIONER
15-30 TON
X
525
28
AIR CONDITIONER
30-50 TON
X
935
.
29
A R CONDITIONER
t TON'
•
560
-•
30
G STORAGE TAN
-
X
910
•
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
..
32
WOOD STOVE - FREE STANDING
X
525
-
VI ENT
• •
SUBTOTAL:
PLUS PROCESSING FEE:
935,00
TOTAL PERMIT FEE DUE:
DAIE:
BANKCARD NUMBER:
Alfri IORIZED SIGNAUIRE:
EXPIRES:
r
0
0
LOT 11
STA: 15+25
16.5' R
INSTALL TYPE
CURB INLET
EL=2035.66
0
c.)
0
z
0
10' WIDE
EASEMENT
FOR UTILITIES
s
CI3Aaddck
LOT 13
S CALE: r'=30'
LOT 12, BLOCK 17
SUMMERFIELD EAST 4th ADD.
ENGINEERS SURVEYORS
1220 N. tiOWATIO ST. 301 NAM NO.
3142XAMT, WA 10201 LEWISTON 40 03001
FAX (500) 324-0423 FAX (204) 71.6-4425
(500) 520-3154
(200 744-2011