2003, 08-12 Permit App: BLD-03-02212 AdditioncrlYo•
6"e\'`
..,00 Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUN/TY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: SO0`l N • CA
A g9z%r„,
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
® BUILDING PERMIT
CI RELOCATION
a CHANGE IN USE 0 GRADING ® MANUFACTURED HOME
El SIGN 113 TENANT
OTHER
OWNER / APPLICANT INFORMATION
® OWNER: C u # ,.14—
APPLICANT:
PHONE: 9 Z%- 27 3 $ FAX: PHONE:
ADDRESS: 5004 /U 5,.,.. 4�g21(p ADDRESS:
CITY,STATE, ZIP
®CONTRACTOR: ® ARCHITECT:
PHONE: FAX: PHONE:
ADDRESS: ADDRESS:
CITY, STATE, ZIP
FAX:
WA ST CONTRACTOR LICENSE #
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT /Dido c)
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS: 21 *33
NUMBER OF STORIES: 2 --
NUMBER
NUMBER of BEDROOMS: 2
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK: 1
LEFT SETBACK: r k
RIGHT SETBACK: 131 4 3 2
150% SLOPES ON PROPERTY:
MAIN FLOOR SQ FT: SU
OCCUPANCY GROUP: 2ND FLOOR SQ FT: '41('
CONSTRUCTION TYPE: fi .: o UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT: 12..
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: 1�a,
CURRENT SEPTIC USE: S;
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
COVERED DECK:
*Wane
. 000Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS: 5 O D - IQ L', \\ , q, ..) CA
PERMIT
USE:
OWNER: C a r ,. r
,. ,LK- '\
X
PHONE (Daytime Contact):
MAILING ADDRESS:
5-6 o'4
A3 , i.... \\.-L...
CA
VJ fze, ii.A.,..s-- & A
91 z- (l0
(street)
X
$6
(city/state)
(ZIP)
CONTRACTOR:
URINALS
LICENSE #:
$6
MAILING ADDRESS:
3
TUBS
PHONE #:
j
X
$6
(street)
4
(city/state)
(ZIP)
PLUMBING FIXTURES
[ETHOD 0
] CASH
ATE: EXPIRES:
ANKCARD NUMBER:
UTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
,
X
$6
-
2
URINALS
X
$6
-
3
TUBS
j
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
1
X
$6
-
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
1
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
-
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
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
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
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
] CHECK
`_-.-- •_-.. _
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
■ NW= •
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
ANKCARD NUMBER:
UTHORIZED SIGNATURE:
S 'lane
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
509-688-0037 - Fax
Spokane Valley, WA 99206
PROJECT
ADDRESS:
DESCRIPTION OF WORK
PERMIT
USE:
OWNER
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
(city/state) (ZIP)
CONTRACTOR:
LICENSE #:
MAILING ADDRESS:
•
PHONE #:
2
(street)
(city/state) (ZIP)
METHOD OF PA
0 CASH 0 CHECK 0
DATE: EXPIRES:
BANKCARD NUMBER.:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
• OR < 100,000
X
515
•
2
FUEL BURNING APPLIANCE
> 100,000
X
519
•
3
UNLISTED APPLIANCE (ADDMONAL FEE)
• OR <4C0,000
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 BTU
X
515
•
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528
•
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539
•
10
BOILER/REFRIGERAT1ON
1001 - 1,750M BTU
X
557
•
11
BOILER/REFRIGERATION
+1750M BTU
X
595
•
12
GAS LOG, GAS INSERT, GAS FIREPLACE
—
X
510
•
13
RANGE
—
X
810
•
14
DRYER
—
X
510
•
15
FUEL BURNING WATER HEATER
—
X
810
•
16
MISC. FUEL BURNING APPL.
—
X
510
•
17
GAS PIPING (ea. Outlet)
—
X
SI
..
18
DUCT SYSTEMS
—
X
810
•
19
VENTILATING FANS
—
Z-
X
810
•
20
AIR HANDLER (DOES NOT Include ducting)
• OR < 10,090CFM
X
512
•
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
519
•
22
EVAPORATIVE COOLERS
—
X
510
•
23
TYPE I HOOD
—
X
850
•
24
TYPE II HOOD
—
X
510
•
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
•
26
AIR CONDMONER
3-15 TON
X
520
•
27
AIR CONDITIONER
15-30 TON
X
525
•
28
AIR CONDITIONER
30-50 TON
X
535
•
29
AIR CONDMONER
+50 TON
X
560
•
30
LPG STORAGE TANK
—
X
510
•
31
WOOD OR PELLET STOVE/INSERT
—
X
510
•
32
WOOD STOVE - FREE STANDING
—
X
$25
-
MENT
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0
DATE: EXPIRES:
BANKCARD NUMBER.:
AUTHORIZED SIGNATURE:
500L\ N. L',\Vc,,) CA-.
APPROVED BY
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