2004, 09-17 Permit App: BLD-04-07687 ResidenceSlane
Jiarnarack.
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Vafley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
G •
EQUIR
11VFORMATION
Street Address: 1 2.O akkh Lano
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
Building Permit
❑ Relocation
❑ Change in Use _ ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
7
Owner:
Phone: %{ I C) I?, Fax:
Address: T0-7 5ou4i-
°k""�
C State
Contractor:
tV P
Phone: rplpw 1 oto F
Address: 1101 Sok-t-k GtnrS�e
�Pc
State
❑ Applicant:
Phone: Fax:
Cd A1C r- Address:
`x/2/2
Zip Code City State Zip Code
y c C5 3 nc ❑
O/C5/3
r
Zip Code
WA State Contractor License #:
Architect:
Phone: Fax:
Address:
City
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIO x G �
C]
# OF STORIES: i
MAIN FLO0 SQ. FTG:2"
QR 1
f
FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: ' '' i ^
DECK/COV. � �ATTIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: eu .
# OF BEDROOMS: n
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30%
30% SLOPES ON PROPERTY:
SEWER ORI N -SITE SEPTIC
SYSTEM? t.1Af-9 r
METHOD 0
0 CASH
-Stiblane
Valley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT
ADDRESS: I 20r -D 'b401_,t-V-1,- \
Uoy r\
PERMIT
USE:
OWNER:V _aci t /\- •-T_c,J
PHONE (Daytime Contact): rrg_/0(2
MAILING ADDRESS: O ' -6 0)(-
G27
7rl#2_ t3Ftra.nt-)81\7Pl
(street)
1
TOILETS
(city/state)
I
(ZIP)
CONTRACTOR:a�
V
A
�JLr
2
LICENSE #:
MAILING ADDRESS:
X
$6
-
PHONE #:
TUBS
'
(street)
$6
-
(city/state)
4
(ZIP)
PLUMBING FIXTURES
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE-
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
$6
-
2
URINALS
X
$6
-
3
TUBS
'
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
-
5
SINKS
LAVS/BASINS, BAR, FLOOR KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
a
X
$6
-
6
DISHWASHER
I
X
$6
-
7
CLOTHES WASHER
I
X
$6
-
8
GARBAGE DISPOSAL
1
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
1
X
S6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS f -
'
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
to
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
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
I
.M' - _ [
'c__ _
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
❑ =BROM ■
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE-
Spokane
Valley
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
ADDRESS-
DESCRIPTION OF WORK
PERMIT
USE:
OWNER-
X
PHONE (Daytime Contact):
MAILING ADDRESS: •
AMOUNT
(street)
(city/state) (ZIP)
CONTRACTOR:
1
LICENSE 11:
MAILING ADDRESS:
-
PHONE Y:
2
(street)
(city/state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
•OR<100,000
1
X
$15
-
2
FUEL BURNING APPLIANCE
> 100,000
X
$19
-
3
UNLLSfED APPLIANCE(ADDITIONAL FEE)
•OR<400,000
X
$50
•
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
•
5
USED APPLIANCE (WSEC mm. AFUE rating)
• or <400,000
X
$50
-
6
USED APPLIANCE (WSEC nun AFUE rating)
>400,000
X
R00
-
7
BOILER/REFRIGERATION
1 -100M BTU
X
$15
-
8
BOILER/REFRIGERATION
101- 500M BTU
X
$28
-
9
BOILER/REFRIGERATION
501- 1,000M BTU
X
$39
-
10
BOILER/REFRIGERATION
1001- 1,750M BTU
X
$57
•
11
BOILER/REFRIGERATION
4-1750M BTU
X
$95
-
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
-
13
RANGE
-
X
$10
-
14
DRYER
-
X
$10
-
15
FUEL BURNING WATER HEATER
-
X
$10
-
16
MISC.FUEL BURNING APPL.
-
a
X
$10
•
17
GAS PIPING (ea Outlet)
-
L
X
$1
-
IB
DUCT SYSTEMS
-
X
$10
19
VENTILATING FANS
1 a
X
$10
•
20
AIR HANDLER (DOES NOT include ducting)
• OR < 10,000CFM
X
$12
-
21
AIR HANDLER (DOES NOT mciude ducting)
> 10,000 CFM
X
$19
-
22
EVAPORATIVE COOLERS
-
X
$10
•
23
TYPE 1 HOOD
-
X
$50
•
24
TYPE ll HOOD
--
X
$10
•
25
HEAT PUMP/AIRCONDITIONER
0-3 TON
iI
X
$12
-
26
AIR CONDITIONER
3-15 TON
X
$20
-
27
AIR CONDITIONER
15-30 TON
X
525
-
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 STOVE/INSERT
-
X
$10
•
32
WOOD STOVE - FREE STANDING
-
X
$25
•
6IENT
SIMMS
VISA 1 ._ _ c .,
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: