2004, 03-16 Permit App: BLD-04-03781 Residence1
Spokane
galley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: c1dger- rt„ El v • .//c2 /
ASSESSOR'S TAX PARCEL NUMBER(S):
Ys7g3 , o3/(7
.LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
O BUILDING PERMIT 0 CHANGE IN USE 0 GRADING
®-SIGN fa TENANT
® RELOCATION
O MANUFACTURED ROME
®OTHER
1
OWNER / APPLICANT INFORMATION
0 OWNER: /L y rIL/%'(
PHONE:R-0g*' Lc--049VFAX:
ADDRESS: Y.236 F a/741/6
CITY,STATE, ZIP
® APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
®CONTRACTOR: ® ARCHITECT.:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SO FT: 01/6-9D =
2ND FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT: I ) ID ()
CRITICAL AREAS: GARAGE: 17°
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
COVERED DECK:
DECK: I0 X 12
Spb*kan
coo/Valley
Project Address: /- 4Q/)759n. Al
Owner t4(ga. Q,fln-F/h$,i4y4
Mailing Address: ,9
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):
License #:
City
State
Phone #:
Zip Code
Mailing Address:
Zip Code
Ci
State
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$15.00
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
$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
=
i
BOILER/REFRIGERATION
1 - 100M BTU
X
515.00
=
8'
BOILERIREFRIGERATION
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
$95.00
=
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
510.00
=
17
GAS PIPING (each oullet)
X
51.00
=
18
DUCT SYSTEMS
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
519.00
=
22
EVAPORATNE COOLERS
X
510.00
=
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
.
X
510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
520.00
=
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
510.00
32
WOOD STOVE - FREE STANDING
X
$25.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
a
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Permit 0 IBLD-04-03781
Permit Type (NEW SINGLE FAMILY RESIDENT
Aa6ess 11121 S EDGERTON RD
SPOKANE VALLEY WA 99212
I Group I Adan Code I AchonDescapbon 1 L oodelion Date I Coupled
III WI Si ,,llSSJ1 V C3 I Cm rrvi I,r la
11 00201 (UNDERGROUND
11 'WATER PIPING
06/01/2004 04:24.17 PM
10/11/200403;2807P14
ill 00203 IDRAINA/ASTE/VENT
10/11/2004 03:2810 FM
1i 00204 IFOCTURES
11 00205 (SEWAGE EJECTOR
11 �IWATER HEATER/TPRV
it
100207 (ROOF DRAINS
11 100351 UNDERGROUND PIPING
111 100301 (VENTILATION
n 100302 DUCTWORK
11 100303
11 Iowa
GAS PIPING
10/29/21904 00 03.14 AM
FURNACE
11
11 100306
11 100307
DAMPER
WOODSTOVE/INSERT
COMBUSTION AIR
11 100308 HEAT PUMP/AIR CONDITIONER
11 00301-9- MISCELLANEOUSAPPLIANCE
11 00310 FIRE DAMPER
11 100311 SMOKE DAMPER
11 00312 HOOD ASSEMBLY
1100313 GAS WATER HEATER
11 00314 (VENTING All
11 00315 PROPANE TANK
1100316 HVAC SYSTEM
10/29/2004 URoa25 AM
1100316 HVAC SYSTEM
11/16/2004 0:36.24 PM
11 194499 FINAL
12 IPerrril Coble
Group Title 1BrikLrg Inspedirrs Group Status 1Wakig
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GddStarderd(b) - Record 1 d 1
Tuesday, Jun 10, 2008 03:15 PM
El Permits
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Man Routnp Status Fee Srmnary Actan Roung tlisroy
Pane It IBLD.04-03781
Perna Tyre !NEW SINGLE FAMILY RESIDENT
I Group I Action Code 1 Action Desaiption
n00107
11 00101
11 00102
11 100,03
11 00104
11 07E—
T-
010511 pen 07
FRAMING
SETBACKS
Address
1121 S EDGERTON RD
SPOKANE VALLEY WA 99212
1 Completion Date
1 Complete Cade
(9/01 /2064 01.2000 PM
05/03/200404:1644 PM
FOOTINGS
05/03/2004 04:1647 PM
REINFORCEMENTS
05/24/2004 04:16.25 PM
BOND BEAMS
ROOF DECK
FRAMING
11/04/2004 69:3321 PM
FRAMING
11 100108
11 00110
[11 00111
„ 110112
NSULATION
11/16/2004 04:36:04 PM
12/02/2004 03:5637 PM
FIREPLACE/CHIMNEY
EXTERIOR FINISH
DRYWALL/FIREWALL
11 100113 SITE DRAINAGE "206'
,1 00116
n om 17
„ 001,9
SPECIAL PROVISIONS
HYDRANTS/STANDPIPES
GENERAL INFORMATION
11 100120 GLAZING
11 100129 (ACTIVE RADON SYSTEM
10,30
11 !-0 201
11 l t�0262
11 11020'
it
002r—
SUB
02
SUB SLAB PASSIVE SYSTEM
UNDERGROUND
06/01/2004 04:24:14 PM
06/D1/2064 04:24:17 PMI
WATER PIPING
10/11/2004 03:2007 PM
DRAIN/WASTE/VENT
10/11/2004 03'.2810 PM
FDRURES
Fr—002E SEWAGE EJECTOR
„ 00206
WATER HEATER/TPRV
111 100207 ROOF DRAINS
n irrran
I1Group Title IBuidrg Inspections
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Glaq Status IWakig
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GoldStardat�b)� Record 1 d 1
Tuesday, Jun 10, 2008 03:15 PM
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REVIEWED BY
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