2004, 04-26 Permit App: BLD-04-04193 Addition*mime
okane
.000%lley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
1
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
RESIDENTIAL ADDITION/REMODEL
Job Address: 4308 S HATHERLY CIR
SPOKANE WA 99206-9492
Description: 12 X 24 FAMILY ROOM ADDITION TO EXISTING MOBILE HOME
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
PERRY, MILFORD J
PERRY, MILFORD J
4308 S HATHERLY CIR
SPOKANE, WA 99206-9492
Application #: BLD -04-04193
Applied: 04/26/2004
Issued:
Expires: 10/23/2004
Lot: Blk: Parcel No: 45334.0324
Phone: (509) 926-6910
Phone:
Lic No:
Zoning:
General Information:
VALUATION
REROOF
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
GAS LOG, INSERT, FIREPLACE
GAS PIPING (ea. OUTLET)
21508
N
13
12 X 24
1
16' 6"
EXISTING
25' 6"
r-3
5-n
2
119 X 96
no
no
1
1
Fees:
PLAN CHECK FEE
BASIC PERMIT FEE
WSBCC SURCHARGE
GAS LOG, INSERT, FIREPLACE
GAS PIPING
Total Calculated:
Deposits/Receipts:
Total Due:
139.70
349.25
4.50
10.00
1.00
504.45
0.00
504.45
THIS IS NOT A RECEIPT
Spokane
jUalley
'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: L]3cc , Pc-rki~ ly
Assessor's Tax Parcel Number(s): 5 33'1,03 2q
Legal Descri tion: Rik -11A e , _ }t i�; ,C%w LCIS &)9t �-JC 1Iv'3k;c�K-
Cc c iAtf/ c>,`� 3 c1,A w
PER IT DESCRIPTION: %i } -'t k % 141 ;Lti _ 4140/kJ
Building Permit
(1 Relocation
n Change in Use n Grading ❑ Manufactured Home
Tenant Improvement n Fire Safety n Other
OWNER/APPLICANT INFORMATION
Owner: (Yl
Phone: dfz ,--�,(j 10 Fax: it./A
Address: y3c; lY C �i
Cf
State Zip, Code
U Contractor:
Phone:
Address:
Fax:
City
State
WA State Contractor License #:
Zip Code
❑ Applicant: Ria,
Phone: Z7(., - ! 2e, 1 Fax: gfit
Address: yec.%: rC t -0 1y6-',
Ly
City State Zip Code
Architect:
Phone:
Address:
Fax:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: !
DIMENSIONS:dd� �) i! �` ,
]` `-�
# OF STORIES: I
MAIN FLOOR TO SQ. FTG:
2"" FLOOR SQ. i -TG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: j
1 \el.-)
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
MANUFACTURED HOME
Width: aC)
Manufacturer:
Length: 5(0* Year: (c16 7 Pit Set:
W x L5)k) frc i nc T --
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation:
Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State Zip
SPECIAL INSPECTIONS
BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone:
Inspector(s):
Fax:
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
Print Name J4/ /J r; <I +.f f f- YQ'Y Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard [1] VISA ❑ Other
Bankcard #:
Authorized Signature:
Expires:
VIN#:
Sfiolane
Project Address:
Owner:
Mailing Address:
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
Permit Use:
Phone (Daytime Contact):
City
Contractor: License #: Phone #:
Mailing Address:
State
Zip Code
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
$15.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
$19.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or Tess 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 Tess 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
1
X
$10.00
=
10.00
13
RANGE
X
$10.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
X
$10.00
=
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
I
X
$1.00
=
=
((�� I,
(, 0 V
18
DUCT SYSTEMS
X
$10.00
19
VENTILATING FANS
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
$19.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE 1 HOOD
X
$50.00
=
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
$10.00
=
32
WOOD STOVE - FREE STANDING
X
$25.00
=
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
Department of Labor & Industries
Factory Assembled Structures Section
INSTRUCTIONS:
1. Complete all spaces, including the signature box (marked with an X).
2. Draw a map on reverse side of WHITE copy only.
3. Forward completed permit and fees to the nearest L&I office. See list on reverse.
4. Contact and schedule the inspection(s) with the same L&I office per the checklist.
MANUFACTURED/MOBILE HOME
ALTERATION PERMIT
tm*tt;
Do not <Mi
complete
shaded
areas
Owner •lastnarne.-
Address
first
'► 1 l
Installer/Contractor/Dealer
Day time phone
( //6
City
Phone
( )
Date
t.
State ZIP
I Contractors registration number
Address
City
State ZIP+4
Serial Number(s)
HUD Number(s)
Place fee amount in proper box
Mechanical
Heat Pump
Air Conditioning
Furnace Installation (gas or electric)
Gas Piping
Wood Stove -
Pellet Stove ----
Gas Room Heater
Gas Decorative Appliance
Range: changing from electric to gas
Gas Water Heater replacement
Water Heater: changing from electric to gas
Sanaa Na, .
5cta1.NQ,: .
Place fee amount in proper box
Electrical
Heat pump
Air Conditioner
Furnace Installation (gas or eldctiFic)';
Wood Stove (if -app ab1e=) F0 213 -W•:'
Pellet Stove f ppUcable)_ z6 _
Gas Room Haf c','_"r;l 15: 7.:3
Gas DecorativkliancO,fftpplicable)
Range: changing from gas to electric
Electric Water Heater replacement
Electric Water Heater replacing Gas Water Heater
Each added or modified circuit
Hot Tub or Spa (power from home electrical panel)
Replace main electrical panel
Low Voltage Fire/Intrusion Alarm
Fire Safety
Plumbing
111 Fire sprinkler system (also requires a plan review)
Each added fixture
Replacement of water piping system
Structural
11 Inspection as part of a mechanical installation
(cut truss/floor joist, sheet rocking)
mi in -e
Reroofs (may require a plan review)
hanges to home when additions bear loads on home per
the design of a professional (also requires a plan review)
Other structural changes (may require a plan review)
Fire Safety
Miscellaneous
Plan review
Reinspection - - - -
Insignia
Other
Note: This permit expires one year after date of purchase. (Non-refundable)
a. Work is completed at this time. An inspection is requested.
Work is NOT completed at this time, I will call when ready.
Make check payable to: Dept. of -Labor & Industries
FEES DUE $
(-Signature of pprmit or authorized representative
el
ire uest rov
Violations must be rorree.
n ay res uit m penaltte:
'u ittat atton
. ........................ .
cause of `specific vao
`within 20 days of t
violations noted ares
iatlons,
he (notice of
n rules and regulations.
.....� ....ure to comply
'-iAX) mfgdr,tobile h alteration permit
1-02> .:
Total pages
White -Olympia Canary,Inspector Green -Contractor:. Pink -Purchaser Goldenrod -Purchaser
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1191-o�/ r
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ADDRESS
LONE
ROAD WIDTH�in l
FRONT. FL'ANKMI(; IDC
COMMENTS nU r {L V J
REVIEWED ev ,j of
!D
PLANNING DEPT. APPROVED
o er a
Cr SttinJ BX' �� C
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s+r�
DATE; "
�r 151 6 �cJ 1l
5 �rr rz,�d,•�rfi�y 1115 ��r
1 1 : 20 YZL%'
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This site plan is being submitted for the purpose of
s
obtaining a,6ullding Permit -and Is a true and correct
iepresetgfiflon of the proposal. All known property
lines/dimensions, curb 11 s,struetaresandessements
have eon Id Iled. Indicated ars wetlands,
bodies of we At pas of critioal areas.
Signed:
�{ Date: 27
005 4/\ALI N / AUL