2003, 10-27 Permit App: BLD-03-02910 Pool, Heater, PipingPROJECT APPLICATION WORK SHEET
SPOKANE COUNTY DIVISION OF BUILDING & CODE. ENFORCF.\IFNI'
102_6 \\'ESI BROADWAY AVENUE
SPOKANE, WA 99260
509-477-3675
SPECIFIC SITE INFORMATION
Sncet Address: ?"
' /(_ S 'r y^l /0 /�, .� ,
Assessor's Tax Parcel Number(s)' / `-/�
Legal Descrtption:
Projccl jcripiion: I/2t Cn-42Ct_ �{� rtjivt.yi c t
Ridding Permit
O Change in Use
O Grading
O Manufactured I-lomc Permit
Rclncall(
O Sign
O Tenant (New/(:hangs)
O Other
1)cpartmerit Use Ord r
LN(jAi t /
( /t
_
T91-477
syy ` 2_s -i0
Water Untncr/Pun t)ne
.
Sncr Distract/Punevor
-
..
Road width -
Setbacks
: Prost.
..-
I<R .
_
Rear ' .
.. Right, ..
School Unmet 2
-
Fra District"
..,,.
o „rchinct/I:nance'
�;t
Zoning
.. .. .
OWNER/APPLICANT INFORMATION
El Lnliode who obnu// be twill Jed .rrrJinp rbrr prom/
01hru Pitons 7a7---vFd /
StS-3-C/ geed_ - ..
LN(jAi t /
( /t
,,,,Knn
- _ `-l . I a_.
T91-477
syy ` 2_s -i0
Nailing .Addrex' 44
'34/6 Sa Foy y
Nailing Addressa
/ L f/ o A)...
‘40-L*12_0(
re\n ^Stateh ppQ- G (C)G
21)
'Marc Lip
Total habitable space
)
❑ fnntrn. D J/- - Pham. 574 _7 / / 3
' (p I. tS. Fax .0-77cL 751 77S}'
o „rchinct/I:nance'
Plum.
I.a.
( )ccupancv group
Nailing na�]/essr, '' M�1 7 ( (1
es,
l'l0 N• C hitt c_RQ(
Naanng address
Cm, Sun Zip
t�'� . `l 9 Z/ 2-
( :m, State Zip
I Ica t source (electro, ,gas, ele)
(
State t ,.nnaetnP mu ft
A C 1 Zo l<3
nntact nan,r
PROJECT INFORMATION
• Building:Information
'guiding ht iglu to peak
# u( stones
Plvn cion ,y. h.
Unfntshrrl basenu nt sy. h
Duransn ms
Total habitable space
2nd 6ianr sy. II
Pnnslied basement sy h.
( )ccupancv group
Construction n pe
Garage sy tr.
Deck sy. to
I:at n(pmjw
I Ica t source (electro, ,gas, ele)
(
,r _
Manufactured Home .
Sign ,
width.
Length:
What is the square fuomge of the sign
face?
I lure high is the sign"
Year
;alike
# at ciao.
Aua of e\i.ung `:Ins
Proposed use
Value
Relocation "
Fire Safety '
Pmn Name
free ions address
Phon.
{ lire Sp nnkl tr
.fent
Paint booth hire Alarm
14rewi irks display
_
Proposed use
Value
Are or will there he wells located on the property?. i
lives, identify on the rile plan 0 \'es 1 0
Special Inspections Required?
Non -Residential Energy Code Compliance?
Pmn Name
Is public U'ater available th the site? „ ❑ Yes 0 No -
..._ .-i _
Phon.
Is the property)ocated wlthm-I000 feet rif a Natural Resource Arca?
'0. Yes:. i❑ No .
Ilan. 1 .ammci
Phone
Inspector,
Is your property in a designated wildlife habitat :wen?
0 Don't knowCD N 0 Yes o
�
Will the site be served by a septic system? 0 Yes NLN" t
Addm.,
Are or will there he wells located on the property?. i
lives, identify on the rile plan 0 \'es 1 0
,,
'
Are there any wetlands, streams or ponds within 200 tee
If yes, identify on site plan 0 Yes 'n
re property?
In.ptvar
Plump
0 Concrete
❑ Welding
0 Bolting
0 Kern fotcemenr
Addy,..
ADDITIONAL SITE INFORMATION
Are there structures 00 the property? it lies 0 No
If yet, ideutift on site plan
Is public sewer available to the site? s ❑ - Yes 0 No
' -
What is the current property size?
(square fret or acres)
Is public U'ater available th the site? „ ❑ Yes 0 No -
..._ .-i _
Is any part of the property within 250 feet of a shticline%
Ify'er, idenN5 on .oieplan 0 les U
Is the property)ocated wlthm-I000 feet rif a Natural Resource Arca?
'0. Yes:. i❑ No .
\Chat is the current use of this property?
Staff Represcn wive
^ � W ^/*�,Q�—
Is your property in a designated wildlife habitat :wen?
0 Don't knowCD N 0 Yes o
�
Will the site be served by a septic system? 0 Yes NLN" t
Is any part of the property within a 100 yr Flood plain?
fees, identq, an sere plan
0 Nfavbe 0 Don't know 0 Yes I 0
Are or will there he wells located on the property?. i
lives, identify on the rile plan 0 \'es 1 0
,,
'
Are there any wetlands, streams or ponds within 200 tee
If yes, identify on site plan 0 Yes 'n
re property?
Is there evidence of fill or excavarion on the property?
❑ YesNn
Are thine slopes greater than 30'% on the property' (30 ft -i •
( V0 0 Yes r.
(100 ft) .
.\re critical or h: 2: rduus materials used or stored un sits"
. 1. 0 Yes
.
DEPARTMENT USE ONLY
Is the property in a designated Stormwater Control Area? i
- - 0 Yes 0 No
Is public sewer available to the site? s ❑ - Yes 0 No
' -
Is the property Inside the ASA?' 0 les 0 No
❑ Yes ❑ No
Is public U'ater available th the site? „ ❑ Yes 0 No -
..._ .-i _
Is the.property inside the PSSA?_ 0 \'es -❑. No
-. .. .
Is the property)ocated wlthm-I000 feet rif a Natural Resource Arca?
'0. Yes:. i❑ No .
Ilam Iteccived
Staff Represcn wive
METHOD OF PAYMENT
VISA
❑ CASH ❑ CHECK CK ❑
011C11IVER
FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD
(M'I'N: If\PlliliS
BANKCAItD NU\IBbR
ALH71OILI'/.IiI) SIGN.\'IURI'
SUBTOTAI.
TOTAL FEE
afINIMUM PERMIT FEE IS 355.00P1.LtSE
MAKE 0Ilif,K.i P.\YAII P. 'ID SPOKANE
- COUNv ITltlt r CLC I Ea
MECHANICAL PERMIT APPLICATION
PROJECT G.� //
ADDRESS: ! /SP S
CCC ��, /�
y� `-
PERMIT /� ,t n
USE: . l RSA_-!P.'.n--�\
MULTI-
PLIED
BY
COST/
UNIT
OWNER: St nitreiie /®��
AMOUNT
PHONE (Daytime Contact). gra 7._ c /� 3 /
Y"?
/UAL
MAILING ADDRESS?ri, !j / (
-f
– OR <100,.000
5/151? -6-2- \J -J fA I
� e- ^ r
tJ b
7! Fcr Q
\/
" /\
–
(Street)
(City/State)
(Zip)
n`
CONTRACTOR: .Y e _
CAU.X_/
r'/1 J
�c��
/
/ `A e
LICENSE:,, J � L cm
(/5.1?
/ ZO kj
MAILING ADDRESS`S:
/c/ia . F+oe_ RL
$ IC
PHONE: c /--f7'(l/ 9
Y"
UNLISTED APPLIANCE (ADDITIONAL CHARGE)
� W(
/UJz
X
(Street)
(City/State)
(Zcp)
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue * Spokane, WA 99260-0050
Telephone No. (509) 477-3675 * Fax No. 477-7198 * TDD No. (509) 477-7133
DESCRIPTION OF WORK
# OF
UNITS
MULTI-
PLIED
BY
COST/
UNIT
EQUALS
AMOUNT
11302
FUEL BURNING APPLIANCE
– OR <100,.000
S'
X
512
–
S —
.B03 -
FUEL BURNING APPLIANCE
>100,000
/
X
515
–
$ IC
1804 i
UNLISTED APPLIANCE (ADDITIONAL CHARGE)
– OR <400,.000
X
550
–
S
:B04'
UNLISTED APPLIANCE (ADDITIONAL CHARGE)
>400,000
X
5100
–
$
:806'
USED APPLIANCE (Must meet WSEC's min AFUE rating)
– OR <400,.000
X
550
–
$
.807-
USED APPLIANCE (Must meet WSEC's min. AFUE acing)
>400,000
X
5100
–
$
:808::
BOILER/REFRIGERATION
1-100M BTU
X
512
–
S
:809.:
BOILER/REFRIGERATION
- 101.500M BTU
X
520
–
$
-B10'
BOILER/REFRIGERATION
501-1,000M BTU
X
525
–
$
8117
BOILER/REFRIGERATION
1,001- 1,750M BTU
X
$35
–
$
.B12'
BOILER/REFRIGERATION
4-1,750M BTU
X
$60
–
$
:B13 .
GAS LOG, GAS INSERT, AND/OR GAS FIREPLACE
-
X
510
–
$
'814:
RANGE-
X
510
–
$
'815.:
DRYER-
X
510
–
$
B16.
FUEL BURNING WATER HEATER
-
X
510
–
$
:B17,
MISCELLANEOUS FUEL BURNING APPLIANCE
-
X
510
–
$
;818:
GAS PIPING (ea. Outlet)
-
i-60---
X
51
–
$ a 1
'B19-
DUCT SYSTEMS
-
X
510
–
$
B20
VENTILATING FANS-
X
510
–
$
-B21
AIR HANDLER (DOES NOT include duct systems)
– OR <10,000 CFM
X
$12
–
$
-B22
AIR HANDLER (DOES NOT include duct systems)
>10,000 CFM
X
$15
–
$
.B23'
EVAPORATIVE COOLERS
-
X
510
–
$
'B24
TYPE I HOOD
-
X
550
–
$
'B25.
TYPE II HOOD-
X
$10
–
$
B26 '
HEAT PUMP/AIR CONDITIONER
0-3 TONS
X
512
–
$
1B27 .
AIR CONDITIONER
3-15 TONS
X
520
–
$
'B28
AIR CONDITIONER
15-30 TONS
X
525
–
$
B29'
AIR CONDITIONER
30-50 TONS
X
535
–
$
B30 '
AIR CONDITIONER
+50 TONS
X
560
–
$
'B31.
LPG STORAGE TANK
-
X
$10
–
$
B32
WOOD OR PELLET STOVE/INSERT
-
X
525
–
S
METHOD
OF PAYMENT
/►y t '
VISA ---+
■
SUBTOTAL
s
PLUS PROCESSING FEE
/ / -7
$ 25.00
MOVER
__
'-- .
■ CASH
II CHECK ID■ 1 -iii
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
EXPIRES:
DATE:
BANKCARD
AUTHORIZED
TOTAL PERMIT FEE DUE
�,(
f G#-
, -MINIMUM PERMIT FEE IS,$35.00.5;;-C4C.
PLEASE -MAKE CHECKS -PAYABLE TO; ,, .
. SPOKANE COUNTY PERMIT,CENTER ,
' - --; -: '' . r. :.. -
NUMBER:
SIGNATURE:
Spokane County Division of Building & Code Enforcement
1026 West Broadway Avenue * Spokane, WA 99260-0050
Telephone No. (509) 477-3675 * Fax No. 477-7198 * TDD No. (509) 477-7133
/5'
APPROVED BY
34th s Fen<
r
City of Spokane Valley
11707 East Sprague Avenue
(509) 921-1000
KICK OWE
E
C
CRT?
N .
BR(
SIF, 2D u irmirrC z rr i}i grhn.
uI� G1.- 11• _ Oom n g
„nl
AVE
169