2005, 04-28 Permit App: 05001359 ResidenceProject Number: 05001359 Inv: I A -plication Date: 04/28/2005 Page 1 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Proiect Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE - Contact: FOLSOM, TODD & ELEANOR
NATURAL GAS Address: 4015 S CONKLIN RD
C - S - Z: GREENACRES, WA 99016-9712
Setbacks: Front 22 Left: 22 Right: 5+ Rear: 24 Phone: (509) 928-6191
Group Name:
Site Information: Project Name: ROW
Plat Key: Name: BEVERLY HILLS 01ST ADD District: Sout
Parcel Number:. 45193.0301 Block: Lot:
SiteAddress: 1012 S CENTER DR Owner: Name: FOLSOM, TODD & ELEANOR
Address: 4015 S CONKLIN RD
Location:: CSV GREENACRES, WA 99016-9712
Zoning: UR -3.5 Urban Residential 3.5 ,
Water District: Hold: ❑
Area: 12,600 Sq Ft Width: 0 Depth: 0 Right Of Way (ft): 0
Nbr of Bldgs: 0 Nbr of Dwellings: 0
Review Information:
Plan
Approach / Drainage
Sewer Review
Permits:
Operator: K_C Printed By: K C Print Date: 1 04/28/2005
Project Number: 05001359 Inv: 1
Application
Date: 04/28/2005
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Approach
Contractor: OWNER
Firm: OWNER
Phone: (000) 000-0000
Item Description
Units Unit Desc
Fee Amount
APPROACH INSPECTION
I NUMBER OF
$25.00
CONST IN ROW - APPROACH
1 NUMBER OF
$25.00
Permit Total Fees:
$50.60
Building Permit
Contractor: OWNER
Firm: OWNER
Phone: (000) 000-0000
Building Characteristics
Group: R-3 Type: VB
Total Area 2325
Building Height 28
Stories 1
Dwelling Units 1
This Application:
Total Project:
Description Grp Type
Notes Sq Ft- Valuation
Scl Ft Valuation
2ND FLOOR R-3 VB
1',264 $94,395.52
1,264 $94,395.52
GARAGE U-1 VB
900 $17,100.00
900 $17,100.00
RESIDENCE R-3 VB
1,061 $79,235.48
1,061 $79,235.48
Totals: 3,225 $190,731.00
3,225 $190,731.00
Item Description
Units Unit Desc
Fee Amount
RESIDENTIAL PERMIT FEE
1 SELECT
$1,503.35
STATE SURCHARGE
1 SELECT
$4.50
RESIDENTIAL PLAN REVIEW
1 SELECT
$601.34
Permit Total Fees:
$2,109.19
Operator: K_C
Printed By: K_C Print Date:
04/28/2005
Page 2 of 4
Project Number: 05001359 Inv: I
Application
Date: 04/28/2005
THIS IS NOT A PERMIT
Penalties will be assessed
for commencing work without a permit
Mechanical Permit
Contractor: OWNER
Firm: OWNER
Phone: (000) 000-0000
Item Description
Units
Unit Desc
Fee Amount
GAS WATER HEATER
1
NUMBER OF
$10.00
GAS APPLIANCE<=100,000BTU
I
NUMBER OF
$12.00
GAS PIPING
5
# OF UNITS
$5.00
HEAT PUMP OR A/C 0-3 TONS
1
NUMBER OF
$12.00
VENTILATING FANS
4
NUMBER OF
$40.00
CLOTHES DRYER
1
NUMBER OF
$10.00
RANGE
1
NUMBER OF
$10.00
GAS LOG OR GAS INSERT
1
NUMBER OF
$10.00
HOOD -TYPE II
1
NUMBER OF
$10.00
Permit Total Fees:
$119.00
Plumbing Permit
Contractor: OWNER
Firm: OWNER
Phone: (000) 000-0000
Item Description
Units
Unit Desc
Fee Amount
TOILETSBIDETS _
3
NUMBER OF
$18.00
SINKS
7
NUMBER OF
$42.00
SHOWERS
1
NUMBER OF
$6.00
TUBS
2
NUMBER OF.
$12.00
DISH WASHERS
1
NUMBER OF
$6.00
GARBAGE DISPOSAL
1
NUMBER OF
$6.00
CLOTHES WASHER
1
NUMBER OF
$6.00
FLOOR DRAINS
1
NUMBER OF
$6.00
CROSS CONNECTION DEVICES
I
NUMBER OF
$6.00
WATER USING DEVICES
1
NUMBER OF
$6.00
Permit Total Fees:
$114.00
Operator: K C, Printed By: K_C Print Date: 04/28/2005
Page 3 of 4.
Proje6t Number: 05001359 Inv: I Application Date: 04/28/2005 Page 4 of 4
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Notes:
LOTS 12 & 16 BLOCK 6 HAVE SPECIAL DRAINAGE REQUIREMENTS PLEASE REFER TO
ENGINEERS
CONTOL AREA FOR DRAINAGE MORITORIUM SEE MAPS FOR SPECIFICS
Payment Summary:
Permit jype Fee Amount Invoice Amount Amount Paid Amount Owing
Approach $50.00 1 $50.00 $0.00 1 $50.00
Building Permit $2,109.19 $2,109.19 $0.00 $2,109.19
Mechanical Permit $119.00 1 $119.00 $0.00 $119.00
Plumbing Permit $114.00 $114.00 $0.00 $114.00
$2,392.19 $2,392.19 $0.00 $2,392.19
Disclaimer:
Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information
,contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K—C Printed By: K—C Print Date: 04/28/2005
1 �
c.II1 �x
BUILDING PERMIT APPLICATION WORKSHEET
t f p ne Valley Community Development Department
a S kane o[E C FEFETy
Building Division
o APR
Val]e 2 1 2005 .11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
D Phone: (509) 688-0036; Fax: (509) 688-0037
D U 0 L DH m (Q .
REQUIRED SITE INFORMATION
Street Address: 012 (,
Assessor's Tax Parcel Number(s): 5 �Ci�• �3� I
Legal Description:
PERMIT DESCRIPTION: 5
Q Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Applicant: j&ALc
Phone: Fax:
Address:
City
❑ Architect:
Phone: _
Address:.
City .
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
State Zip Code
Fax:
State Zip Code
HEIGHT TO PEAK: ���
DIMENSIONS: �„
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
Owner: .TML4
� -e) ea o
Of -FD Is o r✓1
M
Phone: 1421i_C0191 I`ll Fax:
z 1—Ll/cil
9
Address: 8015
5.�
k-1 i n d
o
HEAT SOURCE:
gee- In ac
re -s W 14
�C) 01 (.0
I
TOTAL HABITA � SPACE:
Ci
State
Zip Code
❑
Contractor:
SEWER OR ON—SITE SEPTIC
f Iu O. 000 1
ti
SYSTEM? 52We,1r
Phone:
Fax:
Address.
Q-
City
State
Zip Code
Applicant: j&ALc
Phone: Fax:
Address:
City
❑ Architect:
Phone: _
Address:.
City .
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
State Zip Code
Fax:
State Zip Code
HEIGHT TO PEAK: ���
DIMENSIONS: �„
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2 Nu FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
5 t
I +
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. TG: .
DECK/COV. PATIO SQ. FTG:
Do
1UnX0'
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
TW
AS
# OF BEDROOMS:f
TOTAL HABITA � SPACE:
IM RVIOUS SURFACE AREA:
`-j
a
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON—SITE SEPTIC
f Iu O. 000 1
SYSTEM? 52We,1r
MANUFACTURED HOME
Width: Length: Year:
Manufacturer:
Previous Address:
Proposed Use: _
RELOCATION
FIRE SAFETY
Pit Set:
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time: _
Valuation: Above/Underground Storage Tank Size:
I WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE I
Plans Examiner: Phone:
Address:
Inspector:
Address:
❑ BOLTING
Firm Name:
I nspector(s):
City.
Phone.-
Authorized
hone:
City
SPECIAL INSPECTIONS
❑ CONCRETE ❑ REINFORCEMENT
Phone:
Fax:
State
,Fax:
State
Fax:
Zip
Zip
❑ WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City,of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the pr -erty owner
Print Nalam!
me 2-ailoel'' vISB ginnntiir,/ l
Method of Payment: (Faxed permit. applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
V iI 111 Building Division
►V Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
;OW-k.y For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: S • 4 • L v K` Permit Use:
Owner. 61 t lSD'WI Phone (Daytime Contact): Col i
Mailing Address: 410/5 Cp�,.(t-livl
City
Contractor License a e� License #:
State Zip Code
Phone #:
Mailing Address:
City State Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST .
-
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
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, JANrrOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
X
$6.00
=
6
DISHWASHER
X
$6.00
-
7
CLOTHES WASHER
X
$6.00
-
8
GARBAGE DISPOSAL
'
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
1 $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
NSTALLATION, 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
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
-
21
PRIVATE SEWAGE DISPOSAUSYS
X
$20.00
-
22
INDUSTRIAL WASTE
INTERCEPTOR
X
$15.00
-
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Project Address:
Owner:
Mailing Address:
MECHANICAL PERMIT APPLICATION
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
lit Contractor: �dum�- License #:
Mailing Address:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Permit Use:
Phone (Daytime Contact): `I Z Cel q /
City
Phone #:
Stale Zip Code
AUTHORIZED SIGNATURE:
M
DESCRIPTION OF WORK
# OF UNITS X
COST - TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00 -
2
FUEL BURNING APPLIANCE
More than 100,000
X
$15.00 -
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 SEC min. AFUE ratio
Equal to or less than 400,000
X
$50.00 -
6
USED APPLIANCE SEC min. AFUE ratio
More than 400,000
X
$100.00 -
7
BOILER/REFRIGERATION
1 =100M BTU
X
$12.00 -
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$20.00 -
9
BOILERIREFRIGERATION
501 - 1,000M BTU
X
$25.00 =
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$35.00 -
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
$60.00 -
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
5 X
$1.00 -
18
DUCT SYSTEMS
1 X
$10.00 =
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 ducting)
Greater than 10,000 CFM
X
$15.00 -
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
$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 -
33
REPAIR & ADDITIONS
X
$15.00 -
34
VENTILATION SYSTEMS
X
$12.00 -
35
VENTILATION MECHANICAL EXHAUST
X
$12.00 =
36
INCINERATOR - RESIDENCE
X
$19.00 -
37
INCINERATOR - COMMERCIAL
X
$22.00 -
METHOD OF PAYMENT:
❑ CASH ❑ CHECK ❑ VISA ❑ MC
CARD #.
DATE:
EXPIRES:
SUBTOTAL
PROCESSING FEE $35.00
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
M
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SPOKANE COUNTY
DEPARTMENT OF BUILDING &]PLANNING
1026 Wes,r BROADWAY AVEN E • SPOICANE9 WA 99260-0050
x�
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Site Information Project Information
Site Address: 1012 S CENTER DR
Parcel Number: 45193.0301
Subdivision:
Block: Lot:
Zoning: UNK Unknown
Owner: FOLSOM, TODD & ELEANOR
Address: 4015 S CONKLIN RD
GREENACRES, WA 99016-9712
Building Inspector: F PALADICHUK
Water Dist: UNKNOWN
Project Number: 05002608 l;►►v:
Permit Use: SEWER CONNECTION
Applicant: FOLSOM EXCAVATING
16701 E VALLEYWAY
VERADALE WA 99037
Contact: FOLSOM EXCAVATING
16701 E VALLEYWAY
1 Issue Date: 4/21/2005
Phone: (509) 591-1232
VERADALE WA 99037 Phone: (509) 891-1232
Setbacks - Front: Left: Right: Rear:
Group Name:
Project Name:
IPermits
Sewer Conneetfon Permit Contractor. FOLSOM EXCAVATING INC License t►: FOLSOB199.4DO
SMER CONNECTION 1 $85.00 PROC'PSSINO FEE 1 515.00
Total Permit Pee: $100.00
FOR SEWER NSPECTIONS CALL (509) 477-3604 UTILITIES 8:30-5:00 PM MONDAY T14RU FRIDAY
Call for inspection prior to cover. ONE WORKING DAY NOTICE REQUIRED.
Contractor or applicant is to field locate and confirm the elevation and position of sewer stub prior to any other excavation.
Sewer stubs are to be checked prior to connection to ensure that they have acceptable grade and arc clear and unobstructed to the main
sewer. Sewer lines should be constructed to allow for gravity flow from the lowest level of the structure.
This permit must be presented to the job site inspector for verification. To locate buried cables, gas piping, water lines, etc.
CALL B1FYORE YOU DIG. (509)456-8000.
STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE "CALL SEFOP-E YOU DIG" CENTER BE
NOTIFIED. CALL BEFORE YOU DIG AT LEAST 2 WORKING DAYS IN ADVANCE, (509)456-S000.
Spokane County Code requires the installer comply with all requirements of the Washington State Dept of Labor and Industries,
including those related to trench safety.
Payment Summary
Total Fees AmountPaid AmountOwine Tran Date Receipt # Payment Amt
$100.00 $100.00 $0.00 4/21/2005 2091 $100.00
Processed By: HOWARD, DAN PERMIT
Printed 0y: WENDEL, GLORIA Page 1 of 1
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