2004, 10-15 Permit App: BLD-04-07925 Residence'
' • BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
Z C E f M ^ 11707 E. Sprague Avenue, Suite 106
• Spokane Valley, WA 99206
U(.'/ D /�- 1004 . Phone: (509) 688-0036; Fax: (509) 688-0037
� -
OIiEgQwI�E D INFORMATION • .
Street Address: /2/2 1
Assessor's Tax Parcel Number(s):
Legal Description: Paitll%naL //lIS //d-IZ "B/kC `s' 4/#d end 7 '7G tc
PERMIT DESCRIPTION: S PYL
[Building Permit ❑ Chan
9 Relocation Change in Use 9 Grading 0 Manufactured Home
9 Tenant Improvement 9 Fire Safety 9 Other
OWNER/APPLICANT INFORMATION
❑ Owner: )_,n/Sey eMS
Phone:S•/et—lo/3 Fax: yy3—ioi3
Address: el 30))6?
)q
Cityt fate%
Zip Code
❑ Applicant:
Phone:
Address:
Fax:
City State
❑ Contractor: �• 0 Architect:
Phone: Fax: Phone: Fax:
Address:
Zip Code
Address:"
City State Zip Code City
WA State Contractor License #:,-//1VSCI0 to (DD(/JContact: &/Ql
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK
DIMENSIONS:
42 X 39
# OF STORIES:" 1
MAIN FLOOR TO SQ. FTG: J/7/
2 ' FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTGv
FINISHED BASEMENT SQ FTG:
GARAGE SQ: FTG: • i4 2
(P
DECK/COV. PATIO SQ. FTG:
l D)
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
64-s
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: "
30% SLOPES ON PROPERTY:,,.‘SEWER
OR ON-SITE SEPTIC
SYSTEM? Se/O/Qq/
Silolane
Valley
Project Address:
Owner:
Mailing Address:
/2/2
MECHANICAL PERMIT APPLICATION
City o/ Spokane Valley Community Development Department
BuitdingDivision
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):
Contractor: ,�(IT,IL /1J4L 40M -e,
Mai ing Address: 7
License #:
Crty
State
Phone #:
Zip Code
G
5
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
/
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 min. 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
1001 - 1,750M BTU
X
557.00
11
BOILER/REFRIGERATION
More than 1 750M BTUX
595.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
/
/
X
510.00
=
13
RANGE
X
510.00
=
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
/
X
510.00
=
16
MISC. FUEL BURNING APPLIANCE .
X
510 00
=
17
GAS PIPING (each outlet)
3
x
51.00
=
18
DUCT SYSTEMS
(r
X
510.00
=
19
VENTILATING FANS
J
X
510.00
=
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
$1000
=
23
TYPE IHOOD
-
X
550.00
=
24
TYPE It HOOD
X
510.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
/
X
512.00
=
26
.AIR CONDITIONER
3-15 TON
X
520.00
27
AIR CONDITIONER
15-30 TON
X
52500
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
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 VLSA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES.
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
Valley
Project Address: /2 / Z // lo -yr,
Owner:
PLUMBING 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:
Phone (Daytime Contact):
Mailing Address -
Contractor. Fp P thiAr/
Maling Address:
City
State Zip Code
License #: Phone #:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
3
X
56.00
=
2
URINALS
X
56.00
=
3
TUBS
Z
X
56.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
X
56.00
=
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
it
X
56.00
=
6
DISHWASHER
/
X
56.00
=
-
7
CLOTHES WASHER
%
X
56.00
=
8
GARBAGE DISPOSAL
/
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL. TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
58.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT. PLUMBING, REVERSAL
INSTALLATION. ALTERATION,
REPAIR, REVERSALS
X
58.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
58.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
,
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR
VATS, TANKS, BOILERS
X
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
58.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code