1991, 05-29 Permit App: 91002945 ResidenceSPOKANE COUNTY DEPARI*AEN OF BUILDINGS
•� W'. 303 BROADWAY AVENUE
SPOKANE, WASHINGTON 99260
(509)456-3675
I certify that I have examined this permit/application, state that the information contained in it and submitted by me or my agent to compile said permit/application is true
and correct, and authorize Spokane County to proceed with processing. In addition, I have read and understand the INSPECTION REQUIREMENTS/NOTICE
provisions included herein and agree to comply with same. All provisions of laws and ordinances governing this type of work will be complied with whether specified
herein or not. I understand that the issuance of this permit/application and any subsequent inspection approvals or Certificates of Occupancy shall not be construed to
give authority to violate or cancel the provisions of any state or local law regulating construction, or as a warranty of conformance with the provisions of any state or local
laws regulating construction.
SIGNATURE OF APPLICATION
OWNER OR AGENT DATE
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Spokane 'County
DEPARTMENT OF BUILDING & SAFETY
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER:24� 'j 2j _ 1 �4
STREET ADDRESS: S
CITY/STATE/ZIP: �'n,�) G(�a
SUBDIVISION:r 4u ptki,
*V2- l,or 1-3,4j JS, ! � V z Ac h-Tsfl )SA .
BLOCK: ID LOT: ZONE: DISTRICT:
LOT AREA:`qIT F/A: WIDTH: 77, `> DEPTH: I% 4ZR/W:
# OF BUILDINGS: ' # OF DWELLINGS: WATER DISTRICT:
OWNER: /� CCp�o► �,M, PHONE:_—_—
MAILING ADDRESS: JJ� Q y J, n k 4)
CITY/STATE/ZIP: 1� ���.�p 6/q?Z1D
CONTACT: PHONE: — —
SETBACKS: — FRONT: LEFT: Lj RIGHT: REAR:
PERMIT USE:
BUILDING INFORMATION /
CONTRACTOR LICENSE NUMBER:
CONTRACTOR:�4) (;T. q )Wl;HONE :
MAILING ADDRESS: i1.
ARCHITECT/ENGINEER: PHONE: — —
MAILING ADDRESS:
NEW: l/ REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: 4-7—e"�2) X 4(WIDTH X DEPTH) SQ. FT.: 12-ff
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
MECHANICAL PERMIT APPUGX1i0N FORM
/Information Worksheet-�--�
JOB STREET ADDRESS : 4 >�G�---
CITY/STATE/ZIP: PARCEL NUMBER:
S' C.� � PHONE NUMBER
OWNER.
MAILING ADD RE S:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) �� (City/State) (Zip)
MECHANICAL WORKSHEET/FEE
DESCRIPTION
SCHEDULE
NUMBER
OF UNITS
X EACH
UNIT
= AMOUNT
DUCTWORK SYSTEM_ _ _ _ _ _ _ _ _ _ _ _ _
WOODSTOVE/INSERT _ _ _ _ _ _ _ _ _ _ _
GAS WATER HEATER ____________
HEATING EQUIPMENT <100,000 BTU _ - _ _ _
HEATING EQUIPMENT +100,000 BTU _ _ - - _
GAS PIPING (EA OUTLET) _ _ _ _ _ _ _ _ _
REFRIG 1-100M BTU (NOT A/C OR HEAT PUMP)
REFRIG 101-500M BTU _ _ _ _
REFRIG 501-1,000M BTU_ _ _ _ _ - _ _
REFRIG 1,001-1,750M BTU- _ _ _ _ _ _
REFRIG +1,750M BTU _ _ _ _ _ _` _ _ _ _
HEAT PUMP & AIR CONDITIONER 0-3^TONS _ _
HEAT PUMP & AIR CONDITIONER 3-15 TONS _
HEAT PUMP & AIR CONDITIONER 15-30 TONS _
HEAT PUMP & AIR CONDITIONER 30-50 TONS _
HEAT PUMP & AIR CONDITIONER +50 TONS _ _
VENTILATING FANS - - - - - - - - - - - -
_ _ _ _ _ _ _ _ _
EVAPORATIVE COOLERS_ 5R -1 -21 -PT -W.-
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD)
TYPE II HOOD
CLOTHES DRYER
RANGE
GAS LOG
MISCELLANEOUS (NOT COVERED ELSEWHERE)_ _
UNLISTED GAS APPLIANCE <400,000 BTU_ _ _
UNLISTED GAS APPLIANCE >400,000 BTU_ _ _
USED APPLIANCE <400,000 BTU_ _ _ _ _ _ _
USED APPLIANCE >400,000 BTU_ _ _ _ _ _ _
AIR HANDLER <10,000 CFM _ _ - _ - _ _ _
AIR.HANDLER >10,000 CFM
x$10.00 =
x 25.00 =
x 10.00 =
x 12.00 =
x 15.00 =
x 1.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 12.00 =
x 20.00 =
x 25.00 =
x 35.00 =
x 60.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 10.00 =
x 50.00 =
x100.00 =
x 50.00 =
x100.00 =
x 12.00 =
x 15.00 =
�
/
SUBTOTAL $
PLUS: PROCESSING FEE + $ 25.00
EQUALS: TOTAL PERMIT
NOTE: MINIMUM PERMIT FEE IS $35.00 FEE DUE _ $
SIGNATURE
Spokane County Department of Building_ and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
(;dj
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP:
OWNER:
PARCEL NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER OF I X EACH
DESCRIPTION I FIXTURES IFIXTURE 1 = AMOUNT
TOILETS
SINKS
SHOWERS
BATH TUBS
KITCHEN SINKS
DISH WASHERS
GARBAGE DISPOSAL
CLOTHES WASHER
UTILITY SINKS
ELECTRIC WATER HEATERS
FLOOR DRAINS
FLOOR SINKS
BAR SINKS
ROOF DRAINS
LAWN SPRINKLER
SEWAGE EJECTOR
WATER SOFTENER
URINAL
DRINKING FOUNTAIN
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
Z
']..
1
/
jx $6.00 =1
jx 6.00 =1
Ix 6.00 =1
j x 6.00 =
(x 6.00 =) I
jx 6.00 =I
x 6.00 = I �...
jx 6.00 =I
Ix 6. GO =I �.
Ix 6.00 =1
jx 6.00 =I
Ix 6.00 =I
Ix 6.00 =I
Ix 6.00 =I
Ix 6.00 =I
6.00 =I
jx 6.00 =)
Ix 6.00 =)
jx 6.00 =I
SUBTOTAL
$
PLUS: PROCESSING FEE+
1
$ 25.00
1
1
EQUALS: TOTAL PERMIT
FEE DUE
1= $
Spokane County Department of Building and Safety
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
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