2003, 05-28 Permit App: BD03-550 ResidenceCity of
SPOKANE VALLEY
Box 1 OWNER
PERMIT # PCO 63 _- 5Z
BUILDING PERMIT APPLICATION •
JOB LOCATION
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP • CORP.
BOX 2 CONTRACTOR'S NAM
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.# I-Fi%�1 N H /0(325-1.373r )LJ/4 EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTAC
ADDRESS
SON OF PROJELT
4L
WAPDLT PHONE
SPci.KR J1i l- ZIP q`ae lri
BOX 4 SEWER AVAILABILITY V L"1) WATER AVAILABILITY Ur
BOX 5 ESTIMATED PROJECT COST) '76 j f EXISTING BLDG. VALUATION $ NJA
BOX 6 PROPERTY TAX ACCOUNT NUMBER
GAL D SCRIP ION
Liorr 4 p/I - C
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER
LOT NUMBER
155 -1 _-
BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR :Q;� E ° IS .21�C), F�
/ BASES- '`T FINISHEEDu \VJ
I , RAA'Y 2 8 ?0037
3RD FLOOR
BASEMENT UNFINISHED
CARPORT
OTHER
/ DECK
TOTAL /
HEIGHT
BOX 8 ( ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
FT.
( ) NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY _SQ. FT.
IMPERVIOUS SURFACE tS ( SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough -ins)
PLEASE USE THE ATTAC
SYSTEMS, HEATING AN
LAWN SPRINKLER SYST
BOX 10 Water Service me
Peril r}" N
UNITS, FIREPLACE IN
BACK FLiW �Ig/E
ea,0 kfokn)
MECHANICAL APPLIANCES
FORM FOR THE LISTING OF ALL APPLIANCES,
S, WATER HEATERS, CONVERSION BURNERS,
S, ET AL.
r
iA
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 BE • MY KNOWLEDGE AND FURTHER THAT 1 AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES • PE -FORM T E W. e •R WHICH THE APPLICATION IS MADE.
OWNER / AGENT
DATE,/ (OVER)
Spokane
42,00;Vailey
MECHANICAL PERMIT APPLICATION
PROJECT
ADDRESS
DESCRIPTION OF WORK
PERMIT
USE: ett) c-i-Pcz 1 77 l
PHON (Daytime Contact):
: q
OWNER:
MAILING
ADDRESS:
AMOUNT
(street) (city/state)
- (zip)
CrTrT '
UC SE #:
eft .,
A- - 10G, 81,0
MAILING ADDRESS:
1-1161 e • CUN 41 L
_ Liicrl,qC
P ONE It:
L-1&)
1 Lios
2
FUEL BURNING APPLIANCE
>100,000
(street) (city/state)
(zip)
DESCRIPTION OF WORK
# OF wars
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPUANCE
= OR<100,000
/
X
$15
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNUSTED APPLIANCE (ADDITIONAL FEE)
=0R<400,000
X
$50
4
UNUSTED APPLIANCE (ADDiTIONAL FEE)
>400,000
X
*100
5
USED APPLLANCE(WSEC mm. AFUE rati.ig)
1. OR400,000
X
550
6
USED APPLIANCE(VVSEC min. AFUE rating)
>400,000
X
$100 4
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
S95
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
..
X
*10
i.3
RANGE
-
X
$10
14
DRYER
-
X
*10
,
15
FUEL BURNING WATER HEATER
-
/
X
510
16
MISCELLANEOUS FUEL BURNING APPL
-
X
510
17
GAS PIPING (ea. Outlet)
-
LI
X
S1
18
DUCT SYSTEMS
-
X
*10
=
19
VENTILATING FANS
-
X
$10
=
20
AIR HANDLER (DOES NOT include ducting)
=OR<10,000CFM
X
512
=
21
AIR HANDLER (DOES NOT Indude ducting)
>10,000CFM
X
*19
22
EVAPORATIVE COOLERS
-
X
$10
23
TYPE I HOoD
-
X
$50
24
TYPE II HOOD
-f
X
*10
25.
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
312
=
26
AIR CONDITIONER
3-15 TON
I
X
520
=
27
AIR CONDITIONER
15-30 TON
X
$25
=
28
AIR CONDONER
30-50 TON
X
*35
29
AIR CONDITIONER
+50TON
X
*60
30
LPG STORAGE TANK
-
•
X
*10
31
WOOD OR PELLET STOVE/INSERT
-
X
. *10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
=
0
r1,17.p.
.
SUBTOTAL
-
anal
CASHit 0 CHECK 0 MIMEIR 0
FAXED PERMITS WILL OBELI' BE ACCEPTED
OF A MAJOR CREDIT
6 t:;4g it; 3 VVDTV FC.
;'
--fc-.P.'
PLUS PROCESSING
FEE
WITH PAYMENT
CARD
TOTAL PERMIT FEE
DUE
PLUMBING PERMIT APPLICATION
PROJECT/9 C v7 -' r
ADDRESS: J
PERMIT
USE:
PHONE (Daytime Contact):
OWNER:
MAILING
ADDRESS:
COST
street) (city/state)
(zip)
CONTRACTOR: iI nim j PL.��l i� ' �.t✓ n(
LICENjS(E�#:
rn
WATER CLOSET, B:3ETS
_A- ci5s- K 0
MAILING
ADDRESS:
I l t' 3) 3 . tin 1.4-m V R_ C
ONE #:
:1,R
--f("1 7 7
ii-t-"r�'j
(city/state)
Cil qq / _
f (zip)
(street)
PLUMING FIXTURES
DATE: L//` /1LJ% Y_
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE: t'
DESCRIPTION
DETAILS
# OF toms
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, B:3ETS
LI'
X
$6
=
2
URINALS-
X
$6
=
3
TUBSX
A
X
$6
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6
=
6
DISHWASHER
X
$6
=
7
CLOTHES WASHER
%
X
$6
=
8
GARBAGE DISPOSAL
r •
..
$6
=
9
WATER SOFTENER
I
X
$6
=
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
1
X
$6
=
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
.
3
X
$6
=
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
=
17
SPRINKLER SYSTEM
/
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLING TANK
X•
$6
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
21
20
MISC PLUMBING FIXTURE_
X
$6
=
•
SUBTOTAL
VISA' • it
■ CASH • CHECK [j
• -i`_" °
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
l5 /�'X %iJ-
'WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE: L//` /1LJ% Y_
BANKCARD NUMBER:
EXPIRES:
AUTHORIZED SIGNATURE: t'
AepROV
0' Utility Easement
20'
t.
Lexington Homes
2307 S. Burns
Prairie Orchard
Lot 2, Block 1
SCALE: 1" = 20'
YE.] 03V0/399A