2004, 06-26 Permit App: BLD-04-04720 Residenceun ••••°\.3/4 t
nut,
VJUN , a zoos
Street Address:
BUILDING PERMIT APPLICATION WORKSHEET
pokane 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
RI /SOS re %f s Pd
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
,J1uilding Permit
❑ Relocation
Neuf biov5 e
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: Key x
Phone: (QS?--S/R
Address: /.l • GHID
reknit,'
City
❑ Contractor:
Phone:
Address:
f.tCe5 it CodE
Fax: fs 3 gar to
f/ 1 e/ G,/
Wk 910,7
State Zip Code
Fax:
city
State Zip Code
WA State Contractor License #:
f
❑ Applicant:
Phone: Fax:
Address:
City
❑ Architect:
Phone:
Address:
State Zip Code
Fax:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:/i G ' '
DIMENSIONS: 4.0 X ¢8
# OF STORIES:
MAIN FLOOR TO SQ: FTG:
/4D7
2"" FLOOR SQ. FTG:
-UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: .
•S-, N55' G i"'0. v.
CONSTRUCTION TYPE:
HEAT SOURCE:
/V 4 6-4,5
# OF BEDRdOMS: •
3
TOTAL HABITABLE SPACE:
i4a7
IMPERVIOUS SURFACE AREA:
_, I,2o
COST OF PROJECT:
60 e
30% SLOPES ON PROPERTY: r
A1/41
SEWE R ON-SITE SEPTIC
EM?
MANUFACTURED HOME
Width:
Manufacturer:
Length:
{;Year:'l 1
,Pit Set:
RELOCATION,
'• t7(' li ,"I , it •
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
# of Heads: Fire Alarm:
Paint Booth:
Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax: -
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
Firm Name:
❑ REINFORCEMENT
Phone:
Inspector(s):
Fax:
❑ 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 property owner.
Print Name eev, 4 Cod fC_ Signature / r�
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ,Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#:
Spo` kan° e�
so/Valley
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: /V (SOS F f(s
Permit Use:
Owner: k -c u / n/ i7 Te •" c 2 Co o L Phone (Daytime Contact): /7 /0 S
Mailing Address: Ai h t 60 A7 14,/ 0-4 s 4,-c,4. IN f�96 77
City State Zip Code
Contractor: License #: Phone #:
Mailing Address:
State
City
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
2-
X
56.00
=
2
URINALS
X
56.00
=
3
TUBS
2-
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
4-
X
56.00
=
6
DISHWASHER
(
X
56.00
=
7
CLOTHES WASHER
(
X
56.00
=
8
GARBAGE DISPOSAL
(
X
56.00
=
9
WATER SOFTENER
X
5600
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
(-
X
56.00
_
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAMS, 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
$6.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
Spo°`kan' e
j%alley
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
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
(
X
515.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$19.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
5100.00
=
5
USED APPLIANCE (WSEC mm. AFUE
rating)
Equat to or less than 400,000
X
$50.00
=
8
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400,000
X
5100.00
=
'
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
557.00
=
11
BOILER/REFRIGERATION
More than 1 750M BTU
X
595.00
=
12
GAS LOG GAS INSERT, GAS FIREPLACE
X
510.00
=
13
RANGE
/
X
510.00
=
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 outlet)
3
X
*t.00
=
18
DUCT SYSTEMS
i
X
510.00
=
19
VENTILATING FANS
9
X
510.00
=
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
S19.00
=
22
EVAPORATIVE COOLERS
X
$10.00
23
TYPE I HOOD
X
$50.00
=
24
TYPE II HOOD
X
- 510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512.00
=
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30TON
X
525.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
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:
❑ CASH CICHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES.
TOTAL PERMIT FEE DUE
AUTHORIZED SIGNATURE:
Zip Code
5s-