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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-