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2003, 05-13 Permit App: BD03-437 ResidenceCity of SPOKANE VALLEY Box 1 OWNER PERMIT # BUILDING PERMIT APPLICATION JOB LOCATION OWNER'S ADDRESS CITY PHONE DESCRIBE JOB W03/7 3/7 THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME ,,nn,60A CONTRACTOR'S ADDRESS 19(1' 14 1 7 Lig PHONE -1517 CITYSKE LSE/ CONTRACTOR'S REG.#ISI 14©r`/CI EXPIRATION DATE (CARD MUST BE PRESENTED AND COPIED 0 VERAFIED) BOX 3 CONTACT PERSON �JCT ADDRESS I 1.;-) C����11 A Al O. '5106k/44\C ZIP CigeRO PHONE ?A 13T7 BOX 4 SEWER AVAILABILITY ¥1? -� Ii] (WATER AVAILABILITY L,E 1D721-702, 5 BOX 5 ESTIMATED PROJECT COST $ / Mr -EXISTING BLDG. VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER ytEG,t DESARU ON' pack_ i k_i E c f7 f� i �r PLA -f PA) - / g5 --C/ / (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing / proposed) 1ST FLOOR/6'0A 2ND FLOOR / 3RD FLOOR / BASEMENT UNFINISHED CARPORT / TOTAL OTHER / BASEMENT FINISHED DECK NO / GARAGE JO HEIGHT TO PEAK OF BUILDING FT. BOX 8 (J`) SINGLE FAMILY ( ) MULTIFAMILY (NO. OF UNITS ( ) COMMERCIAL / INDUSTRIAL ( ) TENANT IMPROVEMENT () NEW CONSTRUCTION ( ) EXISTING STRUCTURE TOTAL AREA OF PROPERTY IMPERVIOUS SURFACE SQ. FT. SQ. FT. BOX 9 PLUMBING FIXTURES (Including rough -ins) MECHANICAL APPLIANCES PLEASE USE THE ATTACHED PLUMBING / MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES, SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS, LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL. BOX 10 Water Service meter size (if known) Also see BOX 4 BOX 11 Septic Tank - Not generally allowed it 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 BEST OF MY KN ')/LEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO PE :'M THE WRK FOR WHICH THE APPLICATION IS MADE. OWNER / AGENT DATE 4/// G' 2 (OVER) 1 hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: Visa Mastercard Expiration Date Print the name of the Holder Signa re OFFICE USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE REMARKS SEPA: EXEMPT NOT EXEMPT FIRE DEPARTMENT APPROVAL REMARKS DISAPPROVAL DATE PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE TYPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL IND. ADD/ALT NEW COMMERCIAL •COMM. ALT/ADD NEW MULTIFAMILY NO. UNITS MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER OCCUPANCY TYPE OF CONSTRUCTION STORIES BUILDING SQ. FT. @ = BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ = BUILDING SQ. FT. @ = TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY DATE ASSIGNED ADDRESS PLUMBING PERMIT APPLICATION DDPROJECT / ADDRESS; SS: �f, / C L'!L PERMIT USE * OF MIS OWNER: COST• PHONE (Daytime Contact): AMOUNT MAILING ADDRESS: TOILETS WATER CLOSET, BIDETS (street) (city/state) $6 COJ�(T�2ACyQ R: �� i UL� f ift LICE I ti / f ��/,(zip) / ! �" cC' 6(t) MA1U G ADDRESS: ii 019 6 4 C . ,tt,k,a, _ . / 1,0 11- 60 o 7 PHONE #: - LI 64- - I Lig' 5 (city/state) (zip) (street) PLUM8INC FIXTURES DESCRIPTION DETAILS * OF MIS X COST• EQUALS AMOUNT 1 TOILETS WATER CLOSET, BIDETS X $6 2 URINALS ✓ X $6 = 3 4 TUBS X $6 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 X $6 6 DISHWASHER X - $6 7 CLOTHES WASHER J l 8 GARBAGE DISPOSAL f . X $6 9 WATER SOFTENER X $6 = 10 ELEC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL X $6 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE / X $6 12 FOUNTAINS, DRINKING X 4.$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 J J X $6 17 SPRINKLER SYSTEM / X $25 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6 •_ 19 MEDICAL GAS per outlet NITROUS, OXYGEN X $6 20 MISC PLUMBING FIXTURE X $6 0 -.-_ - • CASH 0 CHECK 0 FAXED PERMITS 1 -ii �i %%� SUBTOTAL , 5, O� I. IIIIIIIIIIIIIIII 0 ........ PLUS PROCESSING FEE $35.00 WILL ONLY BE ACCEPTED VFITH PAYMENT OF A MAJOR CREDIT CARD ...,�....._ TOTAL PERMIT FEE DUE Orr ar +/'" ��r► Spokane .0,001c Valley MECHANICAL PE PROJECT ADDRESS: r!i�} I ! A -/(6.a.A.7),(2....._. PERMIT USE: PHONE (Daytime Contact): OWNER: MAILING ADDRESS: (street) (city/state) • (zip) CONTRA` T�(OOR/�t �/�y�I Rm. �/y� / l5 i 18 1 1 �iC.% LICEN,/S�EE #:MAILQCON INI / 1 1 p � 6/ fJ g . KP PHOr.104 ADDRESS: - 111 W/1 cka--, 91�/ (street) (city/state) / (zip) 1 BANKCARD NUMBER: AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF N/TS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE = OR<100,000 X $15 = / 2 FUEL BURNING APPLIANCE >100,000 1 X $19 = 3 UNLISTED APPLIANCE (ADDITIONAL FEE) =0R<400,000 X $50 = 4 UNLISTED APPLIANCE (ADDITIONAL FEE) >400,000 X $100 = 5 USED APPUANCE(WSEC min. AFUE rating) =OR<400,000 X $50 = 6 USED APPLIANCE(WSEC min. AFUE rating) >400,000 X $100 = 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 BTUX $95 = 12 GAS LOG, GAS INSERT, GAS FIREPLACE - ` / X $10 `� 13 RANGE - i. X $10 1 0 14 DRYER - /j X $10 15 FUEL BURNING WATER HEATER - X $10 = 16 MISCELLANEOUS FUEL BURNING APPL - / X $10 = 17 GAS PIPING (ea. Outlet) - X $1 = LI 18 DUCT SYSTEMS - X $10 = 19 VENTILATING FANS - X $10 = NO 20 AIR HANDLER (DOES NOT include ducting) =0R<10,000CFM X $12 = 21 AIR HANDLER (DOES NOT include ducting) >10,000CFM X $19 = 22 EVAPORATIVE COOLERS - X $10 = 23 TYPE I HOOD - X $50 = 24 TYPE 1I HOOD - / X $10 = 1('� 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 = 26 AIR CONDITIONER 3-15 TON / X $20 2 Q 27 AIR CONDITIONER 15-30 TON / X $25 = 28 AIR CONDITIONER 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 = 111111.111111111 CASH • CHECK • MOM ■ FAXED PERMITS WILL ONLY BE ACCEPTED OF A MAJOR. CREDIT FRPTRFC• f SUBTOTALWU P°ATI 12A s �� • PLUS PROCESSING FEE $35.00 DATE:.5/1-/t.'")-) WITH PAYMENT CARD TOTAL PERMIT FEE DUE 1 BANKCARD NUMBER: AUTHORIZED SIGNATURE: N Road 82.8' Lexington Homes ,72// .4, ,(360,,,d Prairie Orchard Lot 3, Block 1 APPROVED SCALE: 1' = 20' //-2,- 3 4u,/a /t1 0147 tevoe /0 1.,-) 1/ 7( cc—e2 7— ) 1/ o/Yee— `/0"-7"i ECIEVWE7 MAY 1 4 2003 UOUDONg