2004, 07-21 Permit App: BLD-04-07191 DuplexSpgkan4,000Vall
ey
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:
Assessor's Tax Parcel Number(s): `f `5 1 1 1 . 1 C 3 �-
Legal Description: 5 P 9 et -1 as a -j IC. Y(' " -Au rlct6s '42-4'7 Eta `$K I k P65- CG -4 C7
PERMIT DESCRIPTION:
Building Permit ❑ Change in Use IIIGrading
Relocation
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑
Owner ,m) .-c-Gd'C'D ✓?
Phone: 2 9/3 Fax:
Address:
kaLne
Contractor:
Phone:
Address:
City
tate
•��
ZpC d
li
State
Zip Code
❑ Applicant: /
Phone:
Address: se
t
�, r iiilaFAiii
t 131 State Zip Code
Ac�i 1iO4
one:
uttrtsaa
Fax:
City -
State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING. INFORMATION
HEIGHT TO PEAK/5-1DIMENSIONS:
S 7D
# OF STORIES: /
MAIN FLOOR TO SQ. FTG 7
2" FLOOR SQ. FTG: ^
U
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FT
GARAGE SQ: FTG:
9`2-4C1o
DECKICOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
Ga -S
# OF BEDROOMS:46
TOTAL HABITABLE SPA3C�
IMPERVIOUS SURFACE(AAR A
COST OF PROJECT:/
�y-�
ROJECT: WOO
�`fl�fQLt/
30%SLOPES ON PROPERTY
I}
SEWER OR ON-S4f PTIC
SYSTEM? f
Sigkane
4Ualley
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
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City
State Zip Code
Contractor: License #: Phone #:
Mailing Address:
City
State
BANKCARD NUMBER: agL....).*
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
R OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
y
X
$6 00
=
2
URINALS
X
$6.00
3
TUBS
/'
��/'
X
$6.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
56.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR. PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56.00
=
6
DISHWASHER
2
X
$6.00
=
7
CLOTHES WASHER
2-
X
56.00
=
8
GARBAGE DISPOSAL
2.-
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
l2.
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER. CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$8.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES'
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER: agL....).*
AUTHORIZED SIGNATURE:
Zip Code
*lane`m
jValley
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
Project Address* Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
Zip Code
City
State
Contractor: License #: Phone #:
Mai ing Address:
c
State
AUTHORIZED SIGNATURE
Zip Code
DESCRIPTION OF WORK
# OF
UNITS�7
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100 000
//
X
315.00
=
2
FUEL BURNING APPLIANCE
More than 100000
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
310.00
=
13
RANGE
aftX
310.00
=
14
DRYER
9
X
$10.00
=
15
FUEL BURNING WATER HEATER
!
X
310.00
=
16
MISC. FUEL BURNING APPLIANCE�
s
X
$10.00
=
17
GAS PIPING (each outlet)
j
X
$1.00
=
18
DUCT SYSTEMS
/
X
$10.00
=
19
VENTILATING FANS
6
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
319.00
=
22
EVAPORATNE COOLERS
X
$10.00
=
23
TYPE 1 HOOD
X
350.00
=
24
TYPE II HOOD
�7
2.
X
$10.00
=
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
335.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
310.00
=
31
WOOD OR PELLET STOVE/INSERT
X
510.00
=
32
WOOD STOVE - FREE STANDING
X
325.00
=
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
0
10
48P .N1#14G D PROVED
20
B?
PP
DATE:
40
OF SP -1222-99
oimpson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGDNNE ROAD, SPOKANE WA., 99212-2789
PHONE (509) 926-1322 FAX (509) 926-1323
Founded 1946
P:\Projects\13501-14000\13926\dwg\HarwoodProp.dwg 07/21/2004 08:29:13 AM PDT
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