2004, 04-15 Permit App: BLD-04-04083 ResidenceSpokane~
4,00.0Ualley
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: / 5 2 X7(��4�
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
(Building Permit ❑ Change in Use
❑ Tenant Improvement
❑ Relocation
❑ Grading ❑ Manufactured Home
Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:l'&2' U./,ia-
Phone:t bg—) ax: �y� - Ida 3
Address: pp 2-
41211/41,),'"e
41211/41,),'"e t/la 461 az-3
State Zip Code
City
❑ Contractor:
Phone:
Address:
�O�A�rrcz-
Fax:
City
State Zip Code
WA State Contractor License #:
Applicant:
Phone:
Address:
Fax:
City
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
�Z;174,C
# OF STORIES:
l'
MAIN FLOOR TO SQ. FTG:
iq q
2N FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:. ` 20
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: T
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
/G'9Y
IMPERVIOUS SURFACE AREA:
_2/
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
Project Addr s:
Owner: A-14
Mailing Address:
Va11ey
Contractor:
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:
Phone (Daytime Contact):
Mai ing Address:
YdeLexi.
City
License #: Phone #:
State
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
1
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)
X
$1.00
=
18
DUCT SYSTEMS
1
X
$10.00
=
19
VENTILATING FANS
5'
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 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
f
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
$60.00
=
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 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
si�1's44,Valley
Project Addre : / 51Z AZ-4-41'
Owner: `"���1' °.l'e C - '
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):
Mailing Address:
yyR6,4,11-(--;
City State Zip Code
Contractor: �?L2 License #: Phone #:
Mailing Address:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
2-
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
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
3
X
$6.00
=
6
DISHWASHER
t
X
$6.00
=
7
CLOTHES WASHER
1
X
$6.00
=
8
GARBAGE DISPOSAL
1
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
2
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:
0 CASH 0 CHECK 0 VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: