2004, 09-27 Permit App: BLD-04-07761 Residenceawe
.00Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: /1-�-5 41441/ --
ASSESSOR'S
&4S /
ASSESSOR'S TAX PARCEL. NUMBER(S):
LEGAL DISCRIPTION:
l T fad l --err
PERMIT DESCRIPTION: cc -
mU1LDING.PERMIT •
CI -RELOCATION
a CHANGE IN USE ® GRADING
SIGN C TENANT
0 MANUFACTURED HOME
Eto"t'R
OWNER / APPLICANT INFORMATION
CI OWNER: i Wt L L .ra•--
PHONE: 7(�'/D�3 FAX: LFt1 3 / l
ADDRESS: D l (� ��! 4ze b
CITY,STATE, ZIP
® CONTRACTOR:
PHONE:
ADDRESS:
CITY,. STATE, ZIP
FAX:
APPLICANT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
El ARCHITECT.:
PHONE:
WA ST CUNTRAC I OK LICENSE
FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30% SLOPES ON PROPERTY:
BUILDING HEIGHT TO PEAK: Z 1 OCCUPANCY GROUP:
BUILDING DIMENSIONS:SP 7Zg CONSTRUCTION TYPE:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY:
NUMBER of BEDROOMS: 2- CRITICAL AREAS:
FLANKING SETBACK: CURRENT PROPERTY SIZE:
FRONT SETBACK: 25 CURRENT PROPERTY USE:
REAR SETBACK: 4/6 CURRENT SEPTIC USE:
LEFT SETBACK: / 7 CURRENT WELL USE:
RIGHT SETBACK: S IMPERVIOUS SURFACE AREA: L K2
1
MAIN FLOOR SQ FT: 9 2
2N0 FLOOR SQ FT:
UNFIN BASEMENT: 5 Y o
FINISHED BASEMENT:
GARAGE: D
COVERED DECK:
DECK: /U d
•"1.„
*lane
Project Address: deKT/e.—
Owner:
Mailing Address:
4-ynK, C s/—
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Phone (Daytime Contact):
Contractor: ono
Mailing Address:
City State
License #: Phone #:
Zip Code
City
State
Zip Code
3
4
8
7
8
9
10
11
12
13
14
15
16
17
18
19
20
DESCRIPTION OF WORK
TUBS
SHOWERS (PER TRAP)
SINKS
DFSHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
WATER SOFTENER
ELECTRIC HOT WATER TANK
FLOOR DRAINS
ROOF DRAINS/OVERFLOW DRAINS
FOUNTAINS, DRINKING
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
SEWAGE EJECTOR
WATER USING DEVICE
CROSS CONNECTION DEVICE
INTERCEPTORS
MEDICAL GAS (per outlet)
MISCELLANEOUS PLUMBING FIXTURE
WATER CLOSET, BIDETS
BATH, STALL, ONSITE BUILT
IAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARYIMEAT
NOTE IF GAS, SEE MECHANICAL
AREA, CASE, COIL TRENCH,
CONDENSATE
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
GRINDER, SUMP PUMP
ICE AHIOR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
VACUUM BREAKER CHECK
VALVE, ANDRP.B.P.D. FOR:
VATS, TANKS, BOILERS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
NITROUS, OXYGEN
#OF
UNITS
2-
f
r
COST
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
36.00
56.00
$6.00
38.00
$6.00
56.00
TOTAL
AMOUNT
METHOD OF PAYMENT:
❑ CASH 0 CHECK
DATE:
0 VISA Q MASTERCARD
EXPIRES:
BANKCARD NUMBER:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
$35.00
00"simi,
..,VaHey
Project AddrenZ)-C (LLe,jte
Owner -tat/
Mailing Address:
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Corriinunily Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL. (509) 688-0054
Permit Use:
Phone (Daytime Contact):
•
Contractor CA, nettiz. paediel License #: City
Mailing Address:
State , Zip Code
Phone #:
City State Zip Code
DESCRIPTIOtIOF WO
OF
uNns X COST
TOTAL
AMOUNT
FUEL BURNING APPLIANCE
quat to or less thaa 100,000
X $15.00
UEt-BURNIPIGAPPL
UNLISTEDAPPLIANCE (Addirtonal Fee)
UNLISTED APPLIANCE (Additional Fee)
USED APPLIANCE (WSEC mb. AFUE
rafl
n14
USED APPLIANCE (WSEC min. AFUE
BOILER/REFRIGERATION
8 B E FRIGERATiON
9 BOILER/REFRIGERAT10N
10 130ILEFUREFRIGERATI N
fl BOtt.E.RIREFRIGERATION
2 GAS LOG, GAS INSERT, GAS FIREPLACE
3 RANGE
4 DRYER
FUEL BURNtNG WATER
6 MtSQ. FUEL BURNING APPLIANCE
7 P PIN
20
2
TING FANS •
AIR HANDLER (DOES NOT Include ducting)
AIR HANDLER (DOES NOT include ducting
22 EVAPORATIVE COOLERS
23 TYPE t HOOD
24 TYPE It HOOD
25
26
27
26
29
0
T PUMP/AIR C0t4lafTt NER •
AIR CONDITIONER
AIR CONDITIONER •
AIR CONDITIONER
AIR CONDITIONER
LPG STORAGE TANK
OD OR PLLET ST V RT
OSTOVE- FREE ST
METHOD OF PAYMENT:
CASH 0 CHECK 0 VtSA 0 MC
CARD ft
AUTHORIZED SIGNATURE:
• ore ft,
Equal to or less than 400,000
• More than 400,000
Equal to Of less than 400,000
More than 400,000
1 -100M BTU •
101 - 500M BTU
501 - 1,000M BTU
1,001 -1,750M BTU
More than 1,750M BTU
Equal to or less than 10,000 CFM
Greater than 10,000 CFM
0,3 TON
3-15 TON
15-3OTON
0 TON
ore thar 5GTON
51 9.00
*50.00
$100.00
650.00
5100.00
$15.00
$28.00
539.00
557.00
595.00
$10.00
510.00
51000
510.00
510.00
51.00
$13.00
510.00
$12.00
519.00
510.00
550.00
$10.00
$12.00
520.00
25.00
535.00
$60.00
510.00
610.00
DATE:
EXPIRES:
PROCESSING FEE
TOTAL PERMIT FEE DUE: