2004, 03-12 Permit App: BLD-04-03756 Pool, Heater, PipingSpokane
as,Valley
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: /0507 Hoc/n /v
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION: l 6 X 36 )t /M ✓-1 /,m, rfiC7l�
❑ Building Permit
❑ Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety it Other
OWNER/APPLICANT INFORMATION
❑ Owner: S -Ii J SprZ0Ae\-)
Phone: 55'2-)yz4/ Fax:
Address: /Ost$ e lchcinA i
90 cFl uL- 1/99-ct4-h hJs4- 9fl- s
City
State Zip Code
❑ Applicant:
Phone:
Address:
Fax:
City
State Zip Code
❑ Contractor: Por) 1- 6.UQ-tzti I = ❑ Architect:
Phone: 922 6,s -t1 Fax: Phone: Fax:
Address: / 3S 29 , .sPan6c/(_.— Address:
5aacini€ I/otuu, 1,44 `7F21G
City State Zip Code
WA State Contractor License #:
City State
-OL- NJI --a(i cPContact:
`i 2 ' %S-rS
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2"11) FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG:
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?
*lane
oValley
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: S(.✓trnmrr4 �j/_/0'0[. /-en.,
..,
Phone (Daytime Contact): 2S()Z-79z
SPo12- fr- , Vrtukt1 Wze>4
City State Zip Code
License#: Po-OL-ti/—ti0i/CP Phone#. "7"(X -65 -6 -5 -
Project Address: 105L / /14-0//94
Owner: fjtM/N) Aa -t
Mailing Address: / OS -OS £ kiocisr15'
Contractor 8)/JC..- 0 -10 -CLO l rC
Mailing Address:
CI
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
519.00
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 40Q000
X
$50.00
=
4
UNLISTED APPLIANCE (Additional Fee) •
More than 400,000
X
$10000
=
5
USED APPLIANCE (WSEC min AFUE
rating)
Equal to or less than 400,000
X
550.00
=
6
USED APPLIANCE (WSEC min. AFUE
rating)
More than 400.000
X
5100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$15 00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528.00
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
$10 00
=
13
RANGE
X
510 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)
X
$1.00
=
18
DUCT SYSTEMS
X
510.00
=
19
VENTILATING FANS
X
510.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10.000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10.000 CFM
X
519.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE I HOOD
X
550.00
24
TYPE II HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
28
AIR CONDITIONER
3-15 TON
X
• 520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER
More than 50 TON
X
$60 00
=
30
LPG STORAGE TANK
-
X
510.00
=
31
WOOD OR PELLET STOVE/INSERT
X
510.00
=
32
WOOD STOVE - FREE STANDING
X
525 00
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES.
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE.
Zip Code