2004, 06-11 Permit App: BLD-04-04591 Residence1
Spokane
40,,Ualley
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: \ `ZOO'(
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit n Change in Use
Relocation n Tenant Improvement
11
Grading Manufactured Home
Fire Safety n Other
OWNER/APPLICANT INFORMATION
Owner: Ltncsej i O n Si Z.nc.
Phone: -)(p' IN Fax: 1443 /01
Address: 1, 0, Fix 30102„
°. opf 2
City State Zip Code
Contractor:
Phone:
Address:
Fax:
City
State Zip Code
r.,
Applicant:
Phone:
Address:
Fax:
City
❑ Architect:
Phone:
Address:
State Zip Code
Fax:
City
State
WA State Contractor License #: Contact:
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMEN5_0§S
# OF STORIES: \
MAIN FLOOR To Q. FTG:
2"" FLOOR SQ. FTG:
UNFIN BEIjIIgIT SQ. FTG:
FINISHED BASEMENT SQ_ FTG:
GARAGE SQ. FTG: �Q O
DECK/COV. PATIO SQ. FTG:
1O 0
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: �1(X.
# OF BEDROOMS: v-2
�
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPESON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? ' WR Jr .
SOlane
Project Address:
Owner:
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
Contractor:
Mailing Address:
License #:
Permit Use:
Phone (Daytime Contact):
"IlDi1/47-11CLVAI \net
'City State
Phone #:
243
Zip Code
Ci
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
X
515.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
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
5100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
$1.00
=
18
DUCT SYSTEMS
,
X510.00
=
19
VENTILATING FANS
.
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12.00
=
21
AIR HANDLER (DOES NOT include ductin_g)
Greater than 10,000 CFM
X
519.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
X
310.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
1
X
512.00
=
26
AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
510.00
=
31
WOOD OR PELLET STOVE/INSERT
X
510.00
=
32
WOOD STOVE - FREE STANDING
X
525.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
S�kane
jUalley
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
Project Address: 12.Def `jC1u' l � � Gi
Owner: l.-- nose,
Mailing Address: 'w. 3Y1
Contractor:
Mailing Address:
Permit Use:
Phone (Daytime Contact):
License #:
State Zip Code
Phone #:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
$6.00
=
2
URINALS
X
$6.00
=
3
TUBS
'
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
6
DISHWASHER
'
X
$6.00
=
7
CLOTHES WASHER
1
X
$6.00
=
8
GARBAGE DISPOSAL
I
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
INSTALLATION, 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
✓j
. "1
�J
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
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
Proposed Plot Plan
1209 So. Custer Street
City of Spokane Valley
County of Spokane, State of Washington
SCALE 1:20 I SEWER & WATER PROVIDED BY CITY OF SPOKANE
E4C-
!efKlD
ZO
N
ADDRESS: N • Cuirck
ZONE: UR 3.5
ROAD WIDTH: 60
FRONT: FLANKING
COMMENTS:
REVIEWED BY:
PLANNING DEPT. APPROVED
DATE: g
The site Plan is being submitted for the purpose of
Obtaining a building permit and is a true and correct
Representation of the proposal. All known property
Lines/dimensions, curb lines, structures and easements
have been identified. Also indicted are wetlands,
5odies of water, steep slopes or other critical areas.
Lindsey Construction, Inc.