2004, 06-11 Permit App: BLD-04-04589 ResidenceSfi�IC''
aolcValley
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: 12IO cmarth L\oyGL
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
4Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
K
Owner: 1 1 r4C.tYnS-3l" Zn('.-
Phone: =* R Into Fax: L -4-M/3)?,
Address: P. p, 'Fp cl
S(Z
U./Styli vwPc 9922?)
City State Zip Code
Contractor:
Phone:
Address:
Fax:
city
Applicant:
Phone:
Address:
Fax:
City State Zip Code
❑ Architect:
Phone: Fax:
Address:
State Zip Code City
WA State Contractor License #: Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:2& x' ^ O
Vl
# OF STORIES:
MAIN FLOG LO SQ. FTG:
L
2" " FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: 1 �l�
DECK/COV. 1 ATO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: C/! I
# OF BEDROOMS: -
TOTAL Hi3�`A SPACE:
IMPERVIOUS SURFACE AREA:
2.1 (D2.
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM? SCA/\(P,{
spoken' ee
,Walley
Project Address'
Owner: Phone (Daytime Contact): SLnFs IEN
Mailing Address:
LINDSEY CONSTRUCTION, INC.
P.O. BOX 30792
S. 31`.Alt, WA 99233
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: •
City
Contractor. License #: Phone #:
State
Mailing Address:
Zip Code
C
Sta
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
Y OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or Tess than 100,000
I
X
515.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE
rating)
Equal to or less than 400,000
X
550.00
=
6
USED APPLIANCE (WSEC mkt. AFUE
rating)
More than 400,000
X
5100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515.00
=
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
557.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
510.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
-
t
X
510.00
=
18
MISC. FUEL BURNING APPLIANCE
-
X
510.00
=
17
GAS PIPING (each outlet)
2..
x
51.00
=
18
DUCT SYSTEMS
I
X
510.00 .
=
19
VENTILATING FANS
,t
X
$10.00
=
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
510.00
=
23
TYPE I HOOD
X
550.00
=
24
TYPE II HOOD .
X
510.00 '
_
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
` l
X
512.00
=
26
AIRCONDmONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
=
28
AIR CONDITIONER
30-50 TON
X
$35.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
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
/Valley
Project Address:
Owner: •
LINDSEY CONSTRUCTION, INC.
BOA 3u/vi
SPOKANE, WA 99223
Mailing Address:
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildngDivision
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:
Phone (Daytime Contact): S..0& 101 3
Contractor. C -,q ,ft'.L
Mailing Address:
State
License #: Phone #:
Zip Code
-c
ty
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
0 OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
2. .
X
58.00
=
2
URINALS
X
58.00
=
3
TUBS
2.
X
56.00
4
SHOWERS (PER TRAP)
BATH, STALL ON-SfE BUILT
X
56.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
3
X
56.00
=
PREP/CULINARY/MEAT
8
DISHWASHER
I
X
$0.00
=
7
CLOTHES WASHER
1
X
58.00
=
8
GARBAGE DISPOSAL
1
X
56.00
=
9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
58.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
58
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR REVERSALS
X
.00
58.00
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
5800
=
16
WATER USING DEVICE
-
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
X
58.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR
VATS, TANKS, BOILERS
X
58.00
=
18
INTERCEPTORS
GREASETRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56,00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
5800
=
METHOD OF PAYMENT: .
❑ CASH 0 CHECK
DATE
❑ VISA 13 MASTERCARD
EXPIRE&
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code