2004, 06-11 Permit App: BLD-04-04593 Residencetty"
Spokane
,Walley
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: 122 0 ' n.A.: -b ' NOy\
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
N1 Building Permit
Li Relocation
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: LtCldSey Cons -k- =rc
Phone: c(42 1013 Fax: ')-IDIS
Address: S7,0. ?AA, 12001 %
V g927
City
City State Zip Code City
Applicant:
Phone:
Address:
Contractor: Sct.XY.Q ,
Phone: Fax:
Address:
City
State Zip Code
WA State Contractor License #:
Sans .
Fax:
State Zip Code
❑ Architect:
Phone: Fax:
Address:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS: 314 x00
# OF STORIES: \
MAIN FLOO� TO \S
FTG:
2"0 FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
t.
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: • o
DECKJCOV. PATIO SQ. FTG:
Q 0
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE: lQs
# OF BEDROOMS: 3
TOTAL HABITABLE SPACE:
12.144
IMPERVIOUS SURFACE AREA:
COST OF PROJECT:
30% SLOPES ON PROPERTY:
SEWER OR ON-SITE SEPTIC
SYSTEM?e,Wejr
•
�GIpOl]Llll"N„,
#Valley
Project Address:
Owner Phone (Daytime Contact):
Mailing Address:
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
State
Contractor: License #: Phone #:
Mailing Address:
Zip Code
Ci
State
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
$15 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
$50.00
=
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
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515 00
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539 00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
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
X
510.00
=
16
MISC FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
X
51.00
=
18
DUCT SYSTEMS
X
$1000
=
19
VENTILATING FANS
X
510.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
$12 00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
$19.00
=
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
X
512.00
=
26
AIR CONDITIONER
3-15 TON
X
$20.00
=
27
AIR CONDITIONER
15-30 TON
X
$25.00
=
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 Q CHECK 0 VISA 0 MC
CARD #.
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
*lane
Walley
Project Address:
Owner:
Mailing Address:
State Zip Code
Contractor: License #: Phone #:
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):
City
Mailing Address:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
• $6 00
=
2
URINALS
X
$6.00
=
3
TUBS
X
5600
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6 00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6 00
=
6
DISHWASHER
X
5600
=
7
CLOTHES WASHER
X
5600
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
56.00
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56 00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
5600
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56 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
56.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD
DATE. EXPIRES:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
00.E9ed £T0I+£44 60S
i\a„
Spokane
,,/'Valley
95:91 v000 ZT 'Jne
DEPARTMENT OF COMMUNITY DEYELoPMENT
CURRENT PLANNING
ADMINISTRATIVE EXCEPTION
APPLICATION AND DETERMINATION
APPLICANT:
MAILING ADDRESS:
CITY:-QnB9-1t,4,4,,_
PART I
PRONE: (Bora)
l 307`1 Z
STATE: lila Zip: 9-1912z3
(WORK) 57,8- /0/3 (CLEC)
FAX '/y3- /DJ,
Non: Ti APPLICANT IS NOT THE OWNER, INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW
LEGAL OWNER: /Q,j-flW
MAILING ADDRESS:
CITY: STATE:
ZIP:
PHONE: (Homs) (wow() (ceu)
TAX PARCEL No: 3<;) //33 • /�b LO STREET ADDRESS OF SITE:
IP
LEGAL DESCRTION: 5 �l z- Loi /14-12- 99 -et C iditazt„pu 7244�J�, Ggj_
O I 1 PC " . /.r' . / es
i
SEcTION(s) 0-3 TOWNSHIP/ zC RANce 43
ZONING CLASSIFICATION: COMPR�E�HFNSIVE PLAN CATEGORY:
W
TYPE OF ADMINISTRATIVE EXCEPTION REQUESTED: . ne-,..-i ,� k4,ye
i2 44Y4-' 4 J 41/j _ t�d At. ,men.! , J
f44, 4t,I-ell 41j/, iostati
2t24a4/1--
EXPLAIN REASON FOR REQUEST:_
.ii .9
/.ice..
i
APPLICABLE SECTION(S) OF ZONING CODE:
NOTE: A SITE PLAN AND SUPPORTIVE DOCUMENTS SHALL BE INCLUDED WITH THIS APPLICATION
£0'20ed £TOT+£44 60G
PART N
LS:9T 4002 zT one
Under Section 14'.412.041 of the City Zoning Code, any person aggrieved by this administrative determination has
the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must
be filed by submitting the appropriate appeal application together with the required fee to the Department of
Community Development Current Planning, within fourteen (14) calendar days after the decision is issued. Upon
receipt of a complete appeal application, a public hearing will be scheduled.
For information or questions, please call (509) 921-1000
£d WdLS:40 4002 0T .6nd £TOT+£44 60S: 'ON Xbd
Rev 6/03
: WfN4
DE'CERMINATION
Flle No: AEI - n `4
The Department of Community Development finds that the information provided by the applicant and required
compliance with the City of Spokane Valley Zoning Code and all other development regulations, does / does not
adverse affect on the adjacent properties nor the public's general health, safety and welfare.
The Department of Community Developm t approve / denies this "Administrative Exemption" as conditioned
below, for the property described in Part I, p o Sections 14.506.000 and 14.506.020 of the Zoning Code.
This administrative exception is subject to the following conditions of approval:
1) This administrative decision shall apply to the subject property indefinitely and may be transferred to future
property owners, heirs or any successor in interest to the property subject to the conditions of approval
contained herein.
2) The applicant and property owner shall comply with all requirements and regulations of the Zoning Code.
3) The applicant shall comply with all applicable development regulations and standards.
4) The applicant and property owner shall comply with the following additional conditions:
' T"
This a4 inistrative exception hereby op.roved this . day of 200 T
-
d
Approved by .. .. its Title: P(tt GJ�
• ,
Under Section 14'.412.041 of the City Zoning Code, any person aggrieved by this administrative determination has
the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must
be filed by submitting the appropriate appeal application together with the required fee to the Department of
Community Development Current Planning, within fourteen (14) calendar days after the decision is issued. Upon
receipt of a complete appeal application, a public hearing will be scheduled.
For information or questions, please call (509) 921-1000
£d WdLS:40 4002 0T .6nd £TOT+£44 60S: 'ON Xbd
Rev 6/03
: WfN4
40'3Jtid £t0t+£44 60S
PART 11
LEGAL OWNER SIGNATURE
LS:91 400E Et 9nU
(Signature of legal owner or representative es authorized by legal owner)
I, G ICE- G S T I g>� (print name) SWEAR OR AFFIRM THAT THE
ABOVE RESPONSES ARE MADE TRUTHFULLY AND TO THE BEST OF MY KNOWLEDGE.
I FURTHER SWEAR OR AFFIRM THAT I AM THE OWNER OF RECORD OF THE AREA PROPOSED
FOR THE ABOVE IDENTIFIED LAND USE ACTION, OR, IF NOT THE OWNER, ATTACHED
HEREWITH IS WRITTEN PERMISSION FROM THE OWNER AUTHORIZING MY ACTIONS ON
HIS/HER BEHALF.
ADDRESS:
_ 3o?9z
-gAL zda 99zz a
A�
(Signature)
(State)
PHONE: 57vg- id /.3
ZIP:
/z, zoo, 4 --
(Date)
NOTARY
(For Part II above)
STATE OF WASHINGTON ) ss:
COUNTY OF SPOKANE )
SUBSCRIBED AND SWORN to before me this / 2- day of a/./117.41— 20Q41
NAL
+DOEYa%s'4
0.44;41ONF t %
lerNOTARY i . 6
PUBUG
Serio;
ov
1en0Lo A t --i a
NOTARY S 6 A'JURE
Notary Public in and for the State of Washington
Residing at:
My appointment expires: 3— 9 -053
DATE SUBMITTED:
FEE: lJ i
1
• PART III
(To be completed by the Planning41--C-ITA
Staff)
RECEIVED BY: T-Lj c. Qil
FILE NO.: f r (] (_ - 3 1- Oct
4d Wd45:40 P002 Et '6nti £t0t+£44 605: '0N XHd
: Wald