2005, 02-16 Permit App: 05000504 Finish BasementSpokane
jUalley
s 5�
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
v, %1/ E
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: 1:3Li,
✓
71)
The� �-
(1 Building Permit n Change in Use n Grading
[-j Relocation Tenant Improvement (l Fire Safety (l Other
P1 Manufactured Home
I
OWNER/APPLICANT INFORMATION
Owner: _T:; r.rr < S 2 C-
Phone: g6c; _1/tic Fax: g(;/ -/o/
Address: /</// 6 Crc,
City
Contractor:
Phone:
State Zip Code
Address:
Fax:
City
State
WA State Contractor License #:
Zip Code
n
Applicant: -Je-' -/ SAc.F
Phone: RL;71-lt/o6, Fax: (i/-/9(_)/
Address: /01/1 ( Cr�..
City State Zip Code
Architect:
Phone: Fax:
Address:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
6,- �14,---5
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2""' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
I.),Li
GARAGE SQ. FTG: .
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
l'l�'
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? ---)4-,c__
MANUFACTURED HOME
Width:
Manufacturer:
Length: Yea'r:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax:
Zip
BOLTING
Firm Name:
City
SPECIAL INSPECTIONS
CONCRETE
State
Zip
Li REINFORCEMENT
Phone:
Inspector(s):
Fax:
WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Developrnent Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash
[1 Check
❑ Mastercard
Bankcard #: I/3C) 3co / 5 ay 739/
Authorized Signature:
,VISA
Expires: 0105 VIN#:
❑ Other
5 70
PLUMBING PERMIT APPLICATION
ne Phone: (509) 688-0036; FAX: (509)688-0037
For Inspections, CaII (509) 688-0054
diValleY
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Project Address: 11l9Il F / L/L Permit Use:
Owner: -J c !-Yh/ SPS Phone (Daytime Contact):
/y91/ CI�wY�
Mailing Address:
Contractor:
Mailing Address:
City
License #:
State Zip Code
Phone #:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
/
X
$6.00
=
6.
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
I✓
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
/
X
$6.00
=
t!v .)
5
SINKS
LAVS/BASINS, BAR, FLOOR, KfTCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
/
X
$6.00
=
6. ex.)
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
$20.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
0 VISA 0 MASTERCARD
EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Sliagane
RSVIEwED FOR CODE COMPLIANCE
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