2004, 09-10 Permit App: BLD-04-07691 Residencete\m...
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City of
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BUILDING PERMIT APPLICATION WORKSHEET
kane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
Valid E INFORMATION
Street Address: 1 2 Solo-th C y- .
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
,,Building Permit
[] Relocation
Lim I
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety ❑ Other
❑ Manufactured Home
OWNER/APPLICANT INFORMATION
Owner: ' c _
Phone: kb ) Dl Fax: Lit -1 D1
Address: 1‘.'-7 a CUJ r
��i�ca Kc rn�
Inift Qq21.2,
City State Zip Code
Contractor: ur =y ('mc\--
Phone: g( -1 tir3 Fax: 14I-1-3- itr5
5
Address: t7 7
Cort
State Zip Code
WA State Contractor License #:
❑ Applicant:
Phone:
Address:
Fax:
City State Zip Code
Architect:
Phone: Fax:
Address:
City State Zip Code
Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMEN, I,p„N 5
# OF STORIES:
MAIN FLOOR 2 SQ. FTG:
461
2' FLOOR SQ. FTG:
UNFIN BAgMENNT SQ. FTG:
"10
FINISHED BASEMENT SQ. FTG:
GARAGE SQ: FTG: r 1, 1,0
DECK/COV. PATIO C 5Q. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
Gt\S
# OF BEDROOMS:
TOTAL I -I ABIIT BBLLE SPACE:
IMPERVAODUS�S FACE AREA:
COST OF PROJECT:
3G% SLOPES ON PROPERTY:
SEWER OR ON- ITE SEPTIC
SYSTEM? {.'"\e1119 V
0/I\M PLUMBING PERMIT APPLICATION
grpolane City of Spokane Valley Community Development Department
BuildingDivision
, V ileY 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
Contractor License #:
City
State
Phone #:
Zip Code
Mailing Address:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
*OF
UNITS
X
COST
m
TOTAL.
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
56.00
2
URINALS
X
86.00
3
TUBS
X
$6,00
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
WOO
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILRY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
_
X
....
=
6
DISHWASHER
1
X
86.00
7
CLOTHES WASHER
1
X
$8.00
8
GARBAGE DISPOSAL
1
X
86.00
9
WATER SOFTENER
X
$6.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
86.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
86.00
=
13
FOUNTAINS, DRINKING
X
$8.00
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERM1ON,
REPAIR, REVERSALS
X
88.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
86.00
-
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
3
X
.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
86.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
86.00
-
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
05.00
EXPIRES:
TOTAL. PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
Sri°lane
40,14lley
Project Address:
Owner: Phone (Daytime Contact):
Mailing Address:
MECHANICAL 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:
Contractor:
Mai ing Address:
License #:
City
State
Phone*
Zip Code
C
State
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
I
X
$15.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$19.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400 000
X
$100.00
=
5
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or less than 400,000
X
$50.00
=
6
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$15.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$95.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
'
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE��
X
$10.00
=
17
GAS PIPING (each outlet)
2.
x
$1.00
=
18
DUCT SYSTEMS
1
X
$10.00
=
19
VENTILATING FANS
3
X
$10.00
=
20
AIR HANDLER (DOES NOT indude ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$19.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
)
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$80.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 1:1MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code