2004, 07-19 Permit App: BLD-04-07097 Garage to Residencesij6"�
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
71
Street Address:
m132.3
13RI /a S Evergreen
Assessor's Tax Parcel Number(s):
Legal Description: data /
L,04f/eeJ- cAeoI Tsar/shop 1'1 ea
Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
PERMIT DESCRIPTION:
❑ Building Permit
❑ Relocation
OWNER/APPLICANT INFORMATION
Owner: Laura f 50. , v, herIak,t'i
Phone: 607 7q 7.s- sFax: 413 -`/ -/S2
Address: ggli Vernon RA MIIg
[-titre-ft 1") 11 15 31)
City
State Zip Code
❑ • Contractor:
Phone: Fax:
Address:
City
State
WA State Contractor License #:
Zip Code
Applicant:!cum' A F ertak,
Phone: 509 q9R- 757s Fax:
Address:
City
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City -
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK t A4-, )'DIMENSIONS:
1/ Belli.,, 5 daon +%ceili,g,y _ �,
• sIa 36 >C 3i
# OF STORIES:
MAIN FLOOR TO SQ. FTG: 7028
7-57/ — 302 meth roon, '
2"" FLOOR SQ. FTG: / 0g',,5-
UNPIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: 3311
DECKICOV.SQ. FTG: /
a?? + /7 Sfipt doubt- .
OCCUPANCY GROUP: t_aCONSTRUCTION
TYPE:
HEAT SOURCE: �/i
g0.s /crud ricr
# OF BEDROOMS: 3
TOTAL HABITABLE SPACEI gO
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 11
92)051146‘
30%SLOPES ON PROPERTY: A
NA
SELWER OR ON-SITE SEPTIC
SYSTEM? L> Snen
MANUFACTURED HOME
Width: Length: Year:
Manufacturer:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm:
Tent:
Valuation: Above/Underground Storage Tank Size:
Fireworks Display: Blasting:
Paint Booth:
DateTTime:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
❑ WELDING
Phone: Fax:
Inspector(s):
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 ri htls granted by any issued permit inure to the roopeeyyy,,ttt wner.00
Print Name l^Q 'P V I `1 elf aYvl Signatureadaa74 die
Method of Payment: (Faxed permit applications will only be accepted with major bankcard).
❑ Cash ❑ Check E Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
Sitio lane
oValley
or 13,-3
Project Address: ) 302.1 Vat 0, L1t_i fee A
Mailing Address:8411tertroA a /4. 11
Contractor: Q<i s !1 w
i G
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:
Phone (Daytime Contact): Sr)? 993= *-5-9-S"ayerCif W,4 98ao5
City State Zip Code
License #: Phone #:
Owner: i--cLu.' O. F Sac ; v he a Ai -t"
State
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
FUEL BURNING APPLIANCE
Equal to or leu than 100 000
/
X
515.00
=
1
FUEL BURNING APPLIANCE
More than 100 000
X
519.00
=
2
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
3
4
UNLISTED APPLIANCE (Additional Fee) -
More than 400000
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE
Equal to or less than 400,000
X
350.00
rating)
USED APPLIANCE (WSEC min. AFUEX
More than 400 000
5100.00
=
6
rating)
BOILER/REFRIGERATION
1 - 100M BTU
X
$15.00
=
7
8
BOILER/REFRIGERATION - - .
. 101 - 500M BTU
X
528.00
=
9
BOILER/REFRIGERATION
501 -1 000M BTU
X
539.00
=
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
357.00
=
10
BOILER/REFRIGERATION
More than 1,750M BTU
X
395.00
=
11
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
510.00
=
13
RANGE
1
- ilool4 D. -p eleCtri c
X
510.00
=
DRYER
kook wp eltcfrk.
I
X
$10.00
=
14
15
FUEL BURNING WATER HEATER
1
X
310.00
=
16
MISC. FUEL BURNING APPLIANCE
X
510.00
=
17/
GAS PIPING (each outlet) ni4 eke 7
3
X
31.00
=
18
DUCT SYSTEMS
X
310.00
=
19
VENTILATING FANS
Al
4
X
510.00
=
20
AIR HANDLER (DOES NOT indude ducting)
Equal to or leu than 10,000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10 000 CFM
X
519.00'
=
22
EVAPORATIVE COOLERS
-
X
510.00
=
24
TYPE I HOOD 7
X
550.00
=
24
TYPE II HOOD 1
X
510.00
25
HEAT PUMP/AIR CONDITIONER
03 TON
/
X
312.00
=
r1 26)
- 7
AIR CONDITIONER i
3-15 TON
X
320.00
=
i 27
AIR CONDITIONER
15-30 TON
X
325.00
=
28
AIR CONDITIONER
3050 TON
X
535.00
=
29
AIR CONDITIONER
More than 50 TON
X
360.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
310.00
=
"
32
WOOD STOVE - FREE STANDING '
-
X
325.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MC
DATE:
SUBTOTAL
PROCESSING FEE
335.00
EXPIRES:
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
Mot,H loo
?alnt+-y
)321 « (/323) 3. cU i green
•
A
l p'1 6
�t 0 vl0 +ruri. 5 0.
4-- /o' y„
35
31
& L —
4.1
c
wAIM
e%set
401k
J
7' =j"
aarane deo[`
9
31
›I
(2r(d floor 13R1 72. 032-7))
•
(3
of e'ta 5,
k--- '-
�„ t
4Vi;,oe00
13'
cior
410y r,
< > J
T 11
IC toot
0(45rcie ,QeaSure'Ai Q4 /_o/l /z '. / tveryveen
1
3�
0(-1
3,1