2003, 06-04 Permit App: BD03-609 DuplexIty of
POKA,NE VALLEY
)x I OWNER Cep
OWNER'S ADDRESS
1-712-1 1=, S-44
DESCRIBE JOB I
I:i
PERMIT #
ING PERMIT APPLICATION I
rMAR1 N '56U gJOB LOCATION 132 S, jSTAt L.N,
CITY PHONE
Tb z.AiLAe..EY
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. NDN - PP.o (=
-----------======------------
�X 2 CONTRACTOR'S NAME
CONTRACTOR'S ADDRESS
CONTRACTOR'S REG.#
T
f
O12bA� 1 Z1 -T160
-----------------------------------
L4-L-M"b PHONE
s , BI -ST GT, CITY V Df� 1, I w �- , b37
EXPIRATION DATE `l - Z I
i-:0
(CARD MUST BE PRESENTED AND COPIED OR VEF IF ,
-________________________________________________________________________
X 3 CONTACT PERSON OF PROJCT I{fiJ KI R-.1L.L/��.1� PHONE �q 43S{o
ADDRESS f4$6V�_
CITY I_gOyF1__ ZIP
X 4 SEWER AVAILABILITY CISIWATER AVAILABILITY YES- C.ptj
X 5 ESTIMATED PROJECT COST $ 2101 C)O[> EXISTING BLDG. VALUATION $
X 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION L_67 -
to I BLUC.k, � � S,ZL.T 00 24 1 T 25 0 I
(IF NECESSARY, PLEASE SU
CENSUS NUMBER
7 BUILDING SQUARE FOOTAGE
3RD FLOOR ___r_
BASEMENT UNFINISHED
CARPORT —r-
---------------_
8 ( ) SINGLE FAMILY
( MULTIFAMILY (NO. OF UN
( Y COMMERCIAL / INDUSTRI
(
) TENANT IMPROVEMENT
P_I b-�,l✓ P,U,p
R4 r=;I I-W,M,
ITA SEPARATE PAGE WITH THE LEGA
NUMBER LG
xisting /proposed) 1 ST FLOOR O 10 1 LF LWW
OTHER / BASEMENT FINISHED —T --
7---K / GARAGE 0 / i►lap
2. )
9 PLUMBING FIXTURES (Including rough -ins
PLEASE USE THE ATTACHED
SYSTEMS, HEATING AND AIR U
--LAWN SPRINKLER SYSTEMS_E
10 Water Service meter size
11 Septic Tank - Not general
Your sewer purveyor and
12 Street use may require a "
Works Department.
HEIGHT TO PEAK OF BUILDING I
FT.
------------
(� NEW CONSTRUCTION
( ) EXISTING STRUCTURE
TOTAL AREA OF PROPERTY Sl ; + - SQ. FT.
IMPERVIOUS SURFACE _ 1121 SQ. FT.
MECHANICAL APPLIANCES ,
JMBING / MECHANICAL FORM FOR THE LISTING OFtl&
ITS, FIREPLACE INSERTS, WATER HEATERS�F41N /ERS1
i'
:K FLOW PREVENTERS, ETAL:ns
known} ----------- Also OXy=====o=_
allowed in the City of Spokane Valley."&r mstances contact
Health District (See BOX 4) 1 7
(reet Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
1FY UNDER THE PENALTYOF PE JURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
SECT TO THE BEST OF MY KNOW EDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
-_.MISES TO PERFORM THE ORK FOR WHICH THE APPLICATION 1S MADE.
Lr_11=11.rr S�,� 5., V_ - �Awl i. - 4-nz
F
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa ' Mastercard
tion
Print the name of the Holder TO }' S , -I R-tL -jJp
Signature
Mir document originally criftM
confidential credit card information 'whjc
a�
and theme oadocoitCW i9:83a30
• t to SOS DA^ destro ed
MKS: FF'O
.u;.
USE ONLY - PLEASE DO NOT WRITE BELOW THIS LINE
PLANNING DEPARTMENT APPROVAL
DISAPPROVAL
REMARKS
SEPA: EXEMPT
SIDE
REAR HEIGHT LIMIT'
NOT EXEMPT
DATE
FIRE DEPARTMEN4PPROVAL
J ' DISAPPROVAL
REMARKS ..
--------
PUBLIC WORKS DEPARTMENT APPROVAL
DISAPPROVAL DATE
TYPE OF JOB: NEVIS PZESIDENCE RES. ADD/ALT NEW INDUSTRIAL
IND. ADD/ALT
DATE
NEW COMMERCIAL COMM. ALT/ADD
NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP.
ROOF OTHER
OCCUPANCY
TYPE OF CONSTRUCTION
_BUILDING SQ. FT.
BUILDING SQ. FT.
BUILDING SQ. FT.
BUILDING SQ. FT.
TOTAL SQ. FT.
BUILDING PERMIT NO.
PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE
MECH. FEE
TOTAL FEES_WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES ; I
AMOUNT DUE
BUILDING DEPARTM,NT APPROVAL
• BY
iI
TOTAL VALUATION .
•
STORIES
DATE
ASSIGNED ADDRESS
C1T1 of
9v� 11707 E. SPRAG UE, STE 106
�00vaneySPOK,4NE VALLEY, WA 99206
(509)688-0036 FAX (509)688-0037
,SITE INFORMATION
Site Address: '1 3 s. j .�5 `J--tcQ Lv-,
Parcel Number:
Subdivision:
Block: Lot:
Zoning: Water Dist:
Owner:
Address:
Building Inspector:
PROJECT TRANSMITTAL:
TRANSMITTAL DATE:
PERMIT INFORMATION
Permit Number: g�o3_600 Issue Date:
Permit Use: r , f
Applicant:
Phone:
Contact:
Phone:
Contractor:
Setbacks — Front: Left: Right: Rear:
APPROVALS
BUILDINGS: 4i
PLANNING:
ENGINEERS:
n I
1) AA I �./\ !l"i ��%i ^i ./ / /7n
WATER DIST:
STORMWATE :
APPROVALS
73
11 01) G2, l9 -no <9 00 bb
2C�S,oa pIu_ly�
IJ-
4
M
019r-\�
$04ne
,;,, O Val ley
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 PL -F_ X
ADDRESS: 3 2 5s
I
PERMIT
USE:
I COST EQUALS
OWNER
1 FUEL BURNING APPLIANCE
PHONE (Daytime Contact): Cl Z
MAILING ADDREESSSS::
1�12-j E. 13T- &-�lF
$15 -
774 KA- 6,0 �Lb0 0
d
(street)
(city/state)
(ZIP)
CONTRACTOR:
LICENSE #:
�K bZ S
MAILING ADDRESS:
466)5 S, 9E5 -T GT,
PHONE A:
VE-4bkLr-- W4,
°icl'd 3-7
(street)
(city/state)
(ZIP)
METHOD OF PAYI
❑ CASH
DESCRIPTION OF WORK
I
AOFUNITS X
I COST EQUALS
AMOUNT
1 FUEL BURNING APPLIANCE
- OR < 100,000
X
$15 -
D
2 FUEL BURNING APPLIANCE
> 100,000
X
S19 -
3 APPLIANCE (ADDITIONAL FEE)
- OR < 400,000
X
Sm -
EUNLISTED
4 UNLISTED APPLIANCE (ADDITIONAL FEE)
1400,000
X
SIoo -
5 USED APPLIANCE (WSEC min. AFUE rating)
- or < 400,000
X
$50 -
6 USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100 -
7 BOILER/REFRICERATION
1 - loom BTU
X
$15 -
8 BOILER/REFRIGERATION
101- 500M 87U
X
$28 -
9 BOILER/REFRIGERATION
501 - 1,000M BTU
X
S39 -
10 BOILER/REFRIGERATION
1001 -1,750M BTU
X
$57
17 IBOILEMEFRICERATION
+1750M BTU
X
$95 -
12 GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
S10 -
a
13 RANGE
-
X
$10 -
Q
14 DRYER
-
X
S10 -
Q
15 FUEL BURNING WATER HEATER
-
X
$10
'2-
16
16 MISC FUEL BURNING APPL.
-
X
S10 -
17 GAS PIPING (ea. Outlet)
-
X
Sl -
18 IDUCTSYS7EMS
_
X
$10 -
19 JVENTILATINGFANS
-
X
S10 -
20 1 AIR HANDLER (DOES NOT include ducting)
- OR < 10,000CFM
X
$12 -
21 AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
S19 -
22 1 EVAPORATIVE COOLERS
-
X
$10 -
23 TYPE I HOOD
-
X
I S50
24 TYPE II HOOD
-
z X
I S10 -
25 1 HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12
26 JAIR CONDITIONER
3-15 TON
X
$20
27 AIR CONDITIONER
15-30 TON
X
S25 -
28 AIR CONDITIONER
30-50 TON
X
S35
29 JAIR CONDITIONER
+50 TON
X
S60
30 1 LPC STORAGE TANK
-
X
$10 -
31 WOOD OR PELLET STOVE/INSERT
-
X
$10 -
32 WOOD STOVE - FREE STANDING
-
X
$25
RENT
YISA'd ,
SUBTOTAL:
PLUS PROCESSING FEE:
TOTAL PERMIT FEE DUE:
0
$35
5
❑ CHECI
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATLIRE:
J
M
EXPIRES:
Cart orl 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
j3U
De Spokane Valley, WA 99206 509-688-0037 - Fax
,,,ovwValley For Inspections, call 509-688-0054
Plumbing Permit Application
PLUMBING FIXTURES
DESCRIPTION DETAILS
S WATER CLOSET, BIDETS
a
15HOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
REVERSAL
LAUNDRY, UTILITY, JANITOR PHOTO, X-
14
SEWAGE EJECTOR
RAY, FOOD, PREP/CULINARY/MEAT
6
DISHWASHER
7
CLOTHES WASHER
ICE AND/OR COFFEE MAKER, HOSE BIB,
8
GARBAGE DISPOSAL
STEAMER, PROOFER, CARBONATOR,
9
WATER SOFTENER
SWAMP COOLER
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
11 FOUNTAINS, DRINKING
73
-THOD OF PAYMENT
-
Y<rSA'
CASH ❑ CHECK C] ]mom❑ 1=
Th: EXPIRES:
VKCARD NUMBER:
IHORIZED SIGNATURE:
w=
WATER PIPING/DRAIN-IN
INSTALLATION, ALTERATION, REPAIR,
WASTE, VENT, PLUMBING.
REVERSALS
REVERSAL
o0aa��
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
"moi
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
17
SPRINKLER SYSTEM
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
19
MEDICAL GAS pu outlet
NITROUS, OxYGEN
ZO
MISC. PLUMBING FIXTURE
-THOD OF PAYMENT
-
Y<rSA'
CASH ❑ CHECK C] ]mom❑ 1=
Th: EXPIRES:
VKCARD NUMBER:
IHORIZED SIGNATURE:
w=
�EMLUUSGMJ�J�
o0aa��
�Amai
"moi
Go X $6 - 31P
X $25 - SQ
X $6 -
X $6 -
X $6
SUBTOTAL: z1 (�
PLUS PROCESSING FEE: $35.
TOTAL PERMIT FEE DUE: 3-
SPOKANE COUNTY DIVISION OF BUILDING
AND CODE ENFORCEMENT
1026 WEST BROADWAY AVENUE • SPOKANE, WA 99260-0050
Site Information Project Information
Site Address: 732 S JERSTAD IN
VERADALE, WA 99037
Parcel Number: 45241.2012
Subdivision:
Block: 2 Lot: 12
Zoning: UNK Unknown
Owner: GOOD SAMARITAN
Address: 17121 E 8TH AVE
GREENACRES, WA 99016-8556
Building Inspector: BOBBY STONE
Water Dist:
Permits
Project Number: 03004023 Inv: 1 Issue Date: 6/9/2003
Permit Use: SEWER CONNECTION - VALLEY RIDGE PUD
Applicant: J S KIRKLAND CO
4005 S BEST CT
VERADALE WA 99037
Contact: J S KIRKLAND CO
4005 S BEST CT
VERADALE WA 99037
Setbacks - Front: Left: Right:
Group Name:
Project Name:
Sewer Connection Permit Contractor: J S KIRKLAND CO
SEWER CONNECTION 1
License #: JSKIRC'029J7
$85.00 PROCESSING FEE
Phone: (509) 891-8211
Phone: (509) 891-8211
Rear:
$15.00
Total Permit Fee: $100.00
FOR SEWER INSPECTIONS CALL (509) 477-3604 UTILITIES 8:30-5:00 PM MONDAY THRU FRIDAY
Call for inspection prior to cover. ONE WORKING DAY NOTICE REQUIRED.
Contractor or applicant is to field locate and confirm the elevation and position of sewer stub prior to any other excavation.
Sewer stubs are to be checked prior to connection to ensure that they have acceptable grade and are clear and unobstructed to the main sewer.
Sewer lines should be constructed to allow for gravity flow from the lowest level of the structure.
This permit must be presented to the job site inspector for verification. To locate buried cables, gas piping, water lines, etc.
CALL BEFORE YOU DIG, (509)456-8000.
STATE LAW RCW 19.122 REQUIRES THAT PRIOR TO ANY EXCAVATION THE "CALL BEFORE YOU DIG" CENTER BE
NOTIFIED. CALL BEFORE YOU DIG AT LEAST 2 WORKING DAYS IN ADVANCE, (509)456-8000.
Spokane County Code requires the installer comply with all requirements of the Washington State Dept of Labor and Industries, including
those related to trench safety.
Payment Summary
Total Fees AmountPaid AmountOwine Tran Date Receipt # Payment Amt
$100.00 $100.00 $0.00 6/9/2003 3570 $100.00
Processed By: SHATTO, JULIE PERMIT
Printed By: WENDEL, GLORIA Page 1 of 1
S P O K A N E
O TT N T Y
U77LMES DNISION A DIVISION OF THE PUBLIC WORKS DEPARTMENT
N. Bruce Rawls, P.E., Utilities Director
GENERAL FACILITIES CHARGE.(GFC)
PAYMENT OPTION SELECTION RECORD
PLEASE NOTE: Form must be filled out accurately and in its entirety, and signed, or a permit will not be issued.
Date: 4?— q-03
Plat Name: U6�� p -bbl P Lot No(s): Block No(s):
Site Address(es): TM (I I Parcel No(s): " TJ l 1
Owner Name: 600 t) h_P l_J 9�oR�uilder Name:
PR/NT Owner's Name
Payment Option Selected (Check One):
PRINT Builder's Name
1. ( ) GFC payment received at issuance of Sewer Connection Permit by
Division of Utilities
2. ( GFC to be paid at closing, at the GFC rate in effect at the time of closing.
3. ( ) GFC payment in 24 equal monthly payments upon establishment of Sewer Billing Account.
Complete one of the following statements.
a. Owner's Statement: I, understand that I will be
billed for the applicable GFC amount in 24 monthly installments. The monthly GFC installments will be added
to my monthly sewer service charges.
b. Builder's Statement: I, �G('iN F-L-u��� understand that because 1
am selecting this option for payment of the GFC, that the purchaser of the home will be responsible for payment
of the applicable GFC in 24 equal monthly installments. I agree to formally disclose to potential buyers of the
property that the GFC charges will be added to the monthly sewer service billings as soon as billing
commences.
Special Conditions: () No ( ) Yes -See Reverse Side of Form
Signature
Date
b.. q-03
Spokane County, Division of Utilities GFC Payment.Option Form, Revised 11/01/01
1026 W. Broadway • Spokane, WA 99260-0430 • (509) 477-3604 FAX: (509) 477-4715 TDD: (509) 477-7133