2003, 06-04 Permit App: BD03-240 ResidenceCity of
SPOKANE VALLEY
Box 1 OWNER
RECE WED
JUN 0 3 2003
I r5u-An
PERMIT_D03-2-V0
BUILDING PERMIT APPLICATION
OWNER'S ADDRESS
DESCRIBE JOB
JOB LOCATION
CITY PHONE
THIS PROPERTY IS OWNED B": SINGLE/MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTORS NAMEL A,(7,77]U IP TE 1..J�.:(( PHONE
CONTRACTOR'S ADDRESS (t.).,e1 f a 1 r, g
CITY
S CKAIL'C:
CONTRACTOR'S REG.#IkX )N H It; 05,3-111- EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIE
i (Lk
OR ERIFIED)
BOX 3 CONTACT PERSON OF PROJECT ► ()CLAW WA DO/ E PHONE � L/ r j )1
ADDRESS %Mt, 11.'5-1`56 L' CITY ZIP
BOX 4 SEWER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
qiER AVAILABILITY x /-1 I L) -TE f
EXISTING BLDG. VALUATION $
LEGAL DESCRIPTION
7-' Ll r3L.<y K) P,Q1- i +�) � 'C 1-1/-1,e D
L PA; -/ 5 7- (.7
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
V-1
CENSUS NUMBER LOT NUMBER — I
BOX 7 BUILDING SQUARE FOOTAGE Existing / proposed) 1 ST FLOORS / 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED
CARPORT / TOTA
DECK
HEIGHT TO PEAK OF BUILDING ;0
BOX 8 ) SINGLE FAMILY
( ) MULTIFAMILY (NO. OF UNITS
( ) COMMERCIAL / INDUSTRIAL
( ) TENANT IMPROVEMENT
NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY
IMPERVIOUS SURFACE
7'42 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 in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor ana 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_-KNOWt:EDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO P RFO M THE WO•K FOR WHICH THE APPLICATION IS MADE.
OWNER / AGENT
DATE
(OVER)
SpIikane
Valley
PLUMBING PERMIT APPLICATION
PROJECT „2 il
ADDRESS: '9,1 I i Atit./1„..7-itAd–,
PERMIT
USE:
DETAILSCOST
* OF UNITS
OWNER: '
,
PHONE (Daytime Contact):
AMOUNT
1
MAILING ADDRESS:
WATER CLOSET, BIDETS
X X
(street) (city/state)
(zip)
G )TRACTOR: i ,. l!
r4(?
71
, _,L ---t. 7 1-61 /
UCENSE #:
f
M NG ADDRESS::
11(,,i) J. ,,,)
(
,,x, ,. .,(::..t,
HO:
P NE It
_ ' i ,(2/7q
3
/14
(city/state) -
967A/6-
(zip)
X
(street)
PLUMBING FIXTURES
BANKCARD NUMBER:
:
./
AUTHORIZED SIGNATURE:
•'>
DESCRIPTION
DETAILSCOST
* OF UNITS
X
,
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X X
$6
ib.....
2
URINALS
•
X
$6
3
TUBS
/
X
$6
.
6
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
-2
X
$6
'` .
/
.2-
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
2
•
6
DISHWASHER
/
X
$6
7
CLOTHES WASHER
X
$6
co,
8
GARBAGE DISPOSAL
/ ,
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, DRINKJNG
X—
13
WATER PIPING/DRAIN-IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$61
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
/
X
S6
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK •
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
,
,!...9
X
.
/
,2•••••
17
SPRINKLER SYSTEM
X
525
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
•
X
•
=
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
S6
=
20
MISC PLUMBING FIXTURE
X
0
-
- -
CASH 0 CHECK cf
FAXED PERMITS
.—
-
SUBTOTAL
/.•
7
Lt„1:-...' -,„
11111131111111 0
PLUS PROCESSING
FEE
42rETEW
._
WILL ONLY BE ACCEPTED wriii PAYMENT
OF MAJOR CREDIT CARD
, .•
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
:
./
AUTHORIZED SIGNATURE:
•'>
*Wane
vatley
MECHANICAL PERMIT APPLICATION
PROJECT
ADDRESS:
J
1Vil
PERMIT y_ .
USE: 1E f ! ciCa j t,1 C r%(�
PHONE (Da me Contact):
OWNER:
MAIUNG ADDRESS:
EQUALS
AMOUNT
(street)
(city/state) • (zip)
"cp TJRACrT;OR:
r
1./1-
/
&,. Ce-( �t�
Ai} 1,(-)11 c/7
(street)
X
UC S #:
' HFAA- I0 '.5“,)
PHONE #:
6 - /
MAILING ADDR SS:
1--1t'icy
%/ �,
(city/state) (zip)
l
BANKCARD NUMBER: r'
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF &NITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR<100,000
/
X
$15
=
/
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=OR<400,000
X
$50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC rain. AFUE :sting)
=OR<400,000
X
$50
=
6
USED APPUANCE(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 BTU
X
$95
=
12
GAS LOG; GAS INSERT, GAS FIREPLACE
-
1
X
$10
=
"
13
RANGE
l
X
$10
=
/e,
14
DRYER
-
/
X
$10
=
./"( ""
15
FUEL BURNING WATER HEATER
-
/
X
$10
=
lL'
16
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
=
17
GAS PIPING (ea. Outlet)
S—
X
$1
=
fj
18
DUCT SYSTEMS
-
X
$10
=
19
VENTILATING FANS
-
X
$10
=
4/v
20
AIR HANDLER (DOES NOT include ducting)
=OR<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 II HOOD
-
1
X
$10
=
/()
25
HEAT PUMP/AIR CONDITIONER
: 0-3 TON
X
512
=
26
AIR CONDITIONER •
3-15 TON
/
X
$20
!ti
27
AIR CONDITIONER
15-30 TON
X
525
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50TON
X
$60
=
30
LPG STORAGE TANK
-
X
$10
=
31
WOOD OR PELLET STOVEIINSERT
-
X
. $10
=
32
WOOD STOVE - FREE STANDING
-
X
$25
_
SUBTOTAL
VISA'
R ash`:
---'.- ;
•
CASH ■ CHECK ■ mem ■
PLUS PROCESSING
FEE
$35-.6e-
3-OF
FAXED PERM/TS WILL ONLY BEACCE.PTED171THPAYI
OFA MAJOR CREDIT
T ATC- .. VIPOTD VC.
EM
CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER: r'
AUTHORIZED SIGNATURE:
NI
ti
ty Easement
Lexington Homes
160'
APPROVED BY
2321 S. Burns
Prairie Orchard
Lot 4, Block 1
SCALE: 1 " = 20'