2004, 02-23 Permit App: BLD-04-03631 Residence411101%11101 414411m%
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNI TY DEVEL OPMENT
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: /%//Q e-
'f3lL� /—,q—NG
ASSESSOR'S TAX PARCEL NUMBER(S): <55,302- / 5/ /—
LEGAL DISCRIPTION:_-g'(-CA'e7UI J(, Gp E / P,) 7)
PERMIT DESCRIPTION:
l BUILDING PERMIT CHANGE IN USE GRADING-
[IRELOCATION ®-SIGN 13 MANUFACTURED HOME
® TENANT 13OEffER_
OWNER /APPLICANT INFORMATION
® OWNER:_ 96
PHONE: FAX: 9 z-7'37(.7
ADDRESS:_ 3-b �q S • G etc fiJd� 5�p�j ��
® CITY,STATE, ZIP
CONTRACTOR:_ S
PHONE: CA V.
ADDRES
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE/�pI,3
® APPLICANT: 5s}7c4,F
PHONE:
ADDRESS:
ARCHITECT.:
PHONE:
F
AX:
CITY, STATE, ZIP
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECTIk , 764- "-
BUILDING HEIGHT TO PEAK: -qf f
BUILDING DIMENSIONS: /O ) -&o
NUMBER OF STORIES. /
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK: 50
OAR SETBACK: Flo
LEFT SETBACK:
RIGHT SETBACK: S
30% SLOPES ON PROPERTY:
O-CCUPANCY GROUP:
CONSTRUCTION TYPE: woa6 PRAu<*
STRUCTURES ON PROPERTY: .AJaO
CRITICAL AREAS:
CURRENT, PROPERTY SIZE: /CO x 7 cro
CURRENT PROPERTY USE: ,.1oN&-
CURRENT SEPTIC USE: No
CURRENT WELL USE: 1)0
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: PIA6
2ND FLOOR SQ FT: A✓eAj&
UNFIN BASEMENT: cl/cl
FINISHED BASEMENT: ,ve.✓a-
GARAGE: vc90
COVERED DECK:
DECK:
al8ox Cos. Z8 z I q Z 310 "
.)Ioo x /N,/(o
'ga5v x /9l, -
� cl
/lo ,7
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, po*Valley
Mechanical Permit Application
ADDRESS: C USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
�c
(street) (city/state) (�)
_ONZRACTOR' LICENSE #:
RAILING ADDRESS:-.
• . PHONE #:
3 i
METHOD OF PA
9CASH Q C
(street) (city/state) (ZIP)
H
O
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE . - OR < 100,000 / X $15
2 FUEL BURNING APPLIANCE > 100,000 X $19
3 UNLISTED APPLIANCE (ADDITIONAL FEE) - OR <400,000 X $50 <
4 UNLISTED APPLIANCE (ADDITIONAL FEE) > 400,000 X $100 =
5 USED APPLIANCE (WSEC min. AFUE rating) - or < 400,000 X- $50 -
6 USED APPLIANCE (WSEC min. AFUE rating) > 400,000 - X $100 =
7 BOLLERIREFRIGERATION 1 - loom BTU X $15 _
8 BOILER/REFRIGERATION 101 - 500M BTU - X $28 =
9 BOILER/REFRIGERATION 501 - 1,000M BTU X $39
10 BOILERIREFRIGERATION 1001-1,750M BTU X $57 -
11 BOILER/REFRIGERATION +1750M BTU - X $95 -
12 GAS LOG, GAS INSERT, GAS FIREPLACE - X $10 =
13 RANGE
14 DRYER _ X $10
- / X $10 _
15 FUEL BURNING WATER HEATER - - X $10
16 MISC. FUEL BURNING APP[„ .--_
-- �_ .. x -----$10 - -
17 GAS PIPING (ea. Outlet) - X $1 -
18 DUCT SYSTEMS X $10
19 VENTILATING FANS - i- X $10 = 4
20 AIR HANDLER (DOES NOT include ducting) - OR < 10,000CFM X $12
c
� 2
21 AIR HANDLER (DOES NOT include ducting) > 10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50
24 TYPE Ir HOOD - X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12
26 AIR CONDITIONER
3-15 TON / X $20
27 AIR CONDITIONER 15-30 TON X $25
28 AIR CONDITIONER
30-50 TON X $35
29 AIR CONDITIONER +50 TON X $60 =
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVEANSERT - X $10 -
32 WOOD STOVE -FREE STANDING - X $25 -
SUBTOTAL:
YMENT _ _ PLUS PROCESSING FEE: $35.00
�• ,ir TOTAL PERMIT FEE DUE:
I CK ❑ ❑ i
DATE: f 1 EXPIRES•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DATE: f 1 EXPIRES•
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
I le
Valley
Plumbing Permit Application 0
PROJECT
X
X
IPTIONFBATH,STALL,
PERMIT
ADDRESS:
•
-
-
-
USE:
OWNER: >
t
X
PHONE (Daytime Contact):
MAILING ADDRESS:
BUILT
X
S t,
1 ` ,
(street)
(city/state)
(Zlp)
CONTRACTOR: i'
j'
sf
LICENSE #:
MAILING ADDRESS:
GARBAGE DISPOSAL
PHONE #:
9
WATER SOFTENER
J
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
(street)
(city/state)
(ZIP)'
PLUMBING FIXTURES
X
X
IPTIONFBATH,STALL,
DETAILS
T, BIDETS
AMOUNT
•
-
-
-
fSINKS
X
TRAP)ON-SITE
BUILT
X
BAR, FLOOR, KITCHEN,
LITY, JANITOR, PHOTO, X-
EP/CULINARY/MEAT
SHER
$6
$6
$6
$6
$6
7
CLOTHES WASHER
r'
8
GARBAGE DISPOSAL
X
9
WATER SOFTENER
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
I
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
12
FOUNTAINS, DRINKING-
RINKING13
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS.
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
16
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
17
SPRINKLER SYSTEM
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
19
20
MEDICAL GAS per outlet
MISC. PLUMBING FL\TURE
NITROUS, OXYGEN
ETHOD OF PAYMENT
VISA'
CASH ❑ CHECK ❑ =M=❑ _._.. -
.TE:
NKCARD NUMBER:
THORIZED SIGNATURE:
EXPIRES:
# OF UNITS
X
X
j COST
$6
$6
$6
$6
$6
1EQUALS1
AMOUNT
•
-
-
-
X
X
X
X
X
$6
$6
$6
$6
$6
-
-
-
_
-
d
r'
X
X
X
X
X
$6
X
$6
$6
-
-
X
X
$6
<
-
X
$6
X $6 -
X $25 -
X $6 -
X $6 -
X $6 -
SUBTOTAL:
PLUS PROCESSING FEE. $35.00 •
TOTAL PERMIT FEE DUE: /v
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