2004, 09-17 Permit App: BLD-04-07685 ResidenceUILDING PERMIT APPLICATION WORKSHEET
211y ofokane Valley Community Development Department
Building Division
0 L D 0 j 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: j 02.. SC: ,t- 1 Custer
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit
❑ Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: Lc �eY Cor- T1- ,
Phone: 5 <' rOi Fax: 3 iUl(
Address: 107
Krt_ f, i, 6192-12
City State Zip Code
Contractor:
Phone: p5(t /Zile Fax: 3 0.46
r.11 ta
� } ...X212
City State
JAddress: /
El
Applicant:
Phone:
Address:
Fax:
City
State Zip Code
El Architect:
Phone: Fax:
Address:
Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:1 I �
# OF STORIES: 2.
x �I ^
MAIN FLOOR TSQ. FTG:
2"" FLOOR SQ. FTG: '
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG: ,Zt,..�vv
DECK/COV. �A`TTIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: ei Cts
# OF BEDROOMS: 3
TOTAL HABITABLE SPACE:
IMPERVIOUS SU FACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? Q
. SpokC1T4' cH' ���1Y1rR
ane
. . Va11ey
Plumbing Permit Application
METHOD OF
0 CASH
DATE:
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS:
DESCRIPTION
PERMIT
USE:
OWNER:
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
(city/state) (ZIP)
CONTRACTOR:
Z
LICENSE #:
MAILING ADDRESS:
-
PHONE #:
2
(street)
(city/state) (ZIP)
PLUMBING FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
Z
X
$6
-
2
URINALS
X
$6
-
3
TUBS
X
$6
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
3
X
$6
6
DISHWASHER
X
$6
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSALIt
X
$6
9
WATER SOFTENER
X
$6
=
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
,
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
✓�
1
�/
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$b
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$b
_
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
=
20
MISC. PLUMBING FIXTURE
X
$6
=
PAYMENT
2 CHECK
MEM
v:Wa.:
' Fes::- ^
._ - =
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
• Winn •
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
cTrr c' !
s ne
Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: 120z c` WI�Jr
PERMIT
USE:
0 OF UNITS
X
COST
OWNER: L, e1 c' �rJ� AC
HONE (Daytime Contact):
��/—/ �
MAILING ADDRESS: 1 �^�
P.0.)cx ! \ I� C4r,yan
\
^-
•-`
/���
1
��2—�
(street)
(city/state
2
(ZIP)
> 100,000
CONTRACTOR: SIr, nt
1 1S
519
LICENSE #:
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
• OR < 400,000
MAILING ADDRESS:
X
PHONE #:
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
-
(street)
(city/state)
USED APPLIANCE (WSEC min. AFUE rating)
(ZIP)
X
METHOD OF PA
0 CASH 0 CHECK
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
0 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
1
X
515
-
2
FUEL BURNING APPLIANCE
> 100,000
X
519
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
• OR < 400,000
X
550
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
-
5
USED APPLIANCE (WSEC min. AFUE rating)
• or < 400,000
X
550
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
7
BOILER/REFRIGERATION
1 - 100M BTU
X
815
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528
-
9
BOILER/REFRIGERATION
501- 1,000M BTU
X
$39
-
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
S57
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
510
-
13
RANGE
-
X
$10
14
DRYER
-
X
510
=
15
FUEL BURNING WATER HEATER
--
X
$10
-
16
MISC. FUEL BURNING APPL.
-
X
510
17
GAS PIPING (ea. Outlet)
-
L
X
51
18
DUCT SYSTEMS
-
19
VENTILATING FANS
-
4X510
X
510
-
20
AIR HANDLER (DOES NOT include ducting)
• OR < 10,000CFM
X
512
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
819
22
EVAPORATIVE COOLERS
-
X
510
23
TYPE I HOOD
-
X
550
24
TYPE II HOOD
--
X
510
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIR CONDITIONER
3-15 TON
X
520
27
AIR CONDMONER
15-30 TON
X
525
28
AIR CONDITIONER
30-50 TON
X
535
29
AIR CONDITIONER
+50 TON
X
$60
30
LPG STORAGE TANK
-•
X
510
=
31
WOOD OR PELLET STOVE/INSERT
-
X
810
-
32
WOOD STOVE - FREE STANDING
X
525
'
'MENT
`rS e
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: