2003, 11-05 Permit App: BLD-03-02989 Residence1
1
Spolian<e
40,00Ualley.
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague A ve Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 01 2.
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
6 . 6.4 2 c Oe,
9l3 a J (7i I
P as+ ci
PERMI DESCRIPTION:
(F IJILDING PERMIT
(RELOCATION
- 0 CHANGE -IN USE 0 GRADING
0 -SIGN Q -TENANT
® MANUFACTURED HOME
]-OTHER
OWNER / APPLICANT INFORMATION
® OWNER:
PHONE: FAX:
ADDRESS:
,�,,j( //►► r CITY,STATE, ZIP
CONTRACTOR:QI..�L1 PP Sc. &cm t� t C'3 'i ® ARCHITECT.:
PHONE: 4g /d%%33 FAX:/ -4y7/
APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
ADDRESS: l (osw L• SEC24A4 dean
CITY, STATE, ZIP a.<
_'
w• rr4031
C
WA ST CONTRACTOR LICENSE # -IFGSGtt y a
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: D C -
BUILDING DIMENSIONS: 411)4 "I 6
'NUMBER OF STORIES:
NUMBER of BEDROOMS: S
FLANKING SETBACK:
FRONT SETBACK: COSI
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
7C
zo
101
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE: Atirt4 k
CURRENT PROPERTY USE: AN
CURRENT SEPTIC USE: gire51 bld'C
CURRENT WELL USE: -ef
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: I 1 110
- 2" FLOOR SQ FT: 1 I u4
UNFIN BASEMENT:
1
FINISHED BASEMENT: 'r
GARAGE: 139 b
COVERED DECK: Z. 59
DECK: (ZO
Spbkanka e��
,,000 Valley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 • 509-688-0037 - Fax
For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT
ADDRESS:
DESCRIPTION OF WORK
-
PERMIT
USE: .
OWNER
COST
EQUALS
PHONE (Daytime Contact):
MAILING ADDRESS:
FUEL BURNING APPLIANCE
• OR < 100,000
1
(street)
(city/state)
(ZIP)
CONTRACTOR O I r/ Qx1Q
LCUL
nwA}4k
LICENSEt:' '
. ` -
MAILING ADDRESS:
X
5
PHONE #:
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
(street)
(city/state)
(ZIP)
METHOD OF PA
0 CASH 0 C
DESCRIPTION OF WORK
S OF :WITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
1
X
515
•
2
FUEL BURNING APPLIANCE
> 100000
X
519
•
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
• OR<400,000
X
. 550
-
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
, > 400,000
X
5100
•
5
USED APPLIANCE (WSEC min AFUE rating)
or < 400,000
X
550
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFRIGERATION
1-100M STU
X
515
-
B
BOILER/REFRIGERATION
101 - 500M BTU
X
528
-
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539
-
10
BOILER/REFRIGERATION
1001 -1,750M BTU
X
557
•
II
BOILER/REFRIGERATION
. +1750M BTU
X
595
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
'
X
510
-
13
RANGE .
-
X
510
-
14
DRYER
-
X
510
•
15
FUEL BURNING WATER HEATER
-
1
X
510
-
16
MISC. FUEL BURNING APPL.
-
X
510
-
17
GAS PIPING (ea. Outlet)
-
3
x
51
•
18
DUCT SYSTEMS
_
X
510
•
19
VENTILATING FANS
-
44
X
510
-
20
AIR HANDLER (DOES NOT include ducting)
• OR<10,000CFM
X
512
-
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
519
•
22
EVAPORATIVE COOLERS
-
X
510
•
23
TYPE I HOOD
-
X
550
•
24
TYPE U HOOD
-
,
X
510
•
25
HEAT PUMP/AIR CONDITIONER
' 0-3 TON
X
512
-
26
AIR CONDITIONER
3-15 TON
X
.520
-
27
AIR CONDITIONER
1.5-30 TON
X
525
-
28
AIR CONDMONER
30.50 TON
X
535
-
29
ARCONDCI7ONER
+50 TON
X
560
-
30
LPG STORAGE TANK
-
X
510
•
31
WOOD OR PELLET STOVE/INSERT
-
X
510
-
32
WOOD STOVE • FREE STANDING
_.
X
525
•
4ENT
-"'�''•'
VISA _ tS"35
SUBTOTAL:
PLUS PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
vIETHOD 0
] CASH
)ATE:
Spbkane
. Va11ey
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS:
DESCRIPTION
DETAILS
PERMIT
USE:
OWNER
COST
EQUALS
PHONE (Daytime Contact):
MAILING ADDRESS:
TOILETS
WATER CLOSET, BIDETS
(street)
X
(city/state) (ZIP)
CONTRACTOR:
``S plAkat QIn) 6
"�
LICENSE 1:. _. .
J
`M
MAILING ADDRESS:
$6
-
PHONE t: •
3
(street)
(city/state) (ZIP)
PLUMBING FIXTURES
;ANKCARD NUMBER
;UTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF CWITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
$6
-
2
URINALS
X
$6
-
3
TUBS
tr.X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
56
-
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILTrY, JANITOR PHOTO, X-(49
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
-
X
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
-
9
WATER SOFTENER
X
$6
-
10
ELECT HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6
- -
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
I
X
$6
-
12
FOUNTAINS, DRINKING
.- -
X -
$6_
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6
-
14
SEWAGE EJECTOR
GRINDER SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER HOSE BIB,
STEAMER, PROOFER, CARBONATOR
SWAMP COOLER
I
19
7
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
'X
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
-
X
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FDCTURE
X
$6
-
PAYMENT
] CHECK
10111111111111
11S11't^?st#[(:
"
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
❑ PEWS ■
TOTAL PERMIT FEE DUE:
;ANKCARD NUMBER
;UTHORIZED SIGNATURE:
- • '
• July 24, 2002
Kenneth & Judith Brown
113 Keller Circle
Folsom CA 95630-7616
: .
25 Z.029
RE: Applicatinn:4110-2684_. _
- Application for a Sewage Disposal System located at:
10921 E Gertrude Drtve 972 6<e.
- -
Your application for a seta& disposal systeni perinit dit the above stated property voided:
August 25, 2001.
0
REGIUNfiL
H
1101 West Gallego Avenge
Spokane, WA 99201-20N
09.324.1100 iet
509.324.1404 ra,
Since it was :not approved by that•date; the apPlitat.iow has been -voided out.- An.expiration
application can be renewed only one time for $55:00 if. accomplished within two years of the
original application date and an agency renewal form is signed by the applicant that there are no Y..:
changes. in the property or adjacent properties. A renewatapplication is valid for one year. :If an;
application is not renewed, then an applicant has to initiate a new application process-With--noW
. .
fees.
If you have any imestionSrplease call the office at (509) 324-1560, ektension 41::- •
Sincerely,
ENVIRONMENTAL HEALTH DIVISION
/ sage
Steven P Holderby, R.S.
Program Manager
SCHD-EHD/96-703/paw
• - •
-40
July 11, 2003
Kenneth R. Brown
250 McAdoo Drive, Apt. 518
Folsom, CA 95630
Re: On -Site Sewage System Application for 10921 E. Gertrude Drive
Dear Mr. Brown:
SPOKANE
LT NH
;Did -S T T
1101 West College Avenu
Spokane, WA 99201-209;
509.324.1500 1 TEL
509.324.1464 I too
www.SRHD.org
This letter is a follow-up to our conversation earlier this week concerning the
requirements for final approval of your on-site sewage system.
Your subsurface soil absorption system (SSAS) and transport line to your SSAS has been
installed and approved by our office. The remaining components of your system that
needs installation are the building sewer line, septic tank, pump chamber, and the sewer
line from the pump chamber to the existing transport line. In order to accomplish this,
you must submit a $55.00 application renewal fee payable to SRHD (Spokane Regional
Health District). This will allow you an additional year to complete your on-site sewage
system. You will also need to contract with a Washington State licensed designer or
engineer to submit a design of the system components listed above and forward to the
Health District for our review and approval prior to installation by a sewage system
installer licensed by the Health District.
Enclosed are lists of licensed engineers and designers for your reference. If you have any
questions concerning this correspondence, please feel free to contact me at (509) 324-
1571.
Sincerely,
ENVIRONMENTAL HEALTH DIVISION
Steven P. Holderby, R.S.
Liquid Waste Program Manager
Enclosure
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