2004, 01-26 Permit App: BLD-04-03455 Addition9
Siokane
4W1eY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMON/TY DEVELOPMENT
BU/LD/NG DIVISION
1-1707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
IZ11S' E t'AAW $poKcwc_ UAU,EA WA clay7.-t
ASSESSOR'S TAX PARCEL NUMBER(S):
4SIS3.7_.t., IL.
LEGALDISCRIPTION: 9,S75-3• Z(n!t+
PERMIT DESCRIPTION: rJEva 3EA4Zoow‘ -1- ENre.1 AAODt•r,oN
UILDING PERMIT ® CHANGE IN USE El GRADING
E] SIGN ® TENANT
®RELOCATION
® MANUFACTURED HOME
['OTHER
OWNER / APPLICANT INFORMATION
1
® OWNER: L(4Ie- f S ()ACAA ® APPLICANT4SA..A E
PHONE: qL-L--ZZOS FAX: Vra S%3 -1z -en
AS OI.J4.JEL&
PHONE: - FAX:
ADDRESS: t -C -11S- C-. iN\An) SQo1'n, e („JA MUG DDRESS:
®CONTRACTOR: C7-'–
CITY,STATE, ZIP
CITY, STATE, ZIP
® ARCHITECT.: 4.r.)4/3 UAAJ OACN
PHONE: %t-ZZc'B FAX: PHONE: ci 2.2 - I CZ -S- FAX:
ADDRESS: ADDRESS:
CITY, STATE, ZIP CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # 'CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJEC# 1 a-anCr)' o£
BUILDING HEIGHT TO PEAK: IC 11'
30% SLOPES ON PROPERTY: -
OCCUPANCY GROUP: (O '
MAIN FLOOR SQ FT: ID CS€{FT
2ND FLOOR SQ FT: !Ufa
BUILDING DIMENSIONS: 0 IS x 18 CONSTRUCTION TYPE: OW P-oc j Foo..jr EllyfruNFIN BASEMENT: ID ZSy,FT
STRUCTURES ON PROPERTY: 2 FINISHED BASEMENT: ,(J/ba
NUMBER of BEDROOMS: 1
NUMBER OF STORIES:
(3GO.SslFT)
CRITICAL AREAS: N /a
FLANKING SETBACK: 31/
FRONT SETBACK: 32-'
REAR SETBACK: /J/A
LEFT SETBACK:
3'1'
RIGHT SETBACK:
3k'
GARAGE: SyO�T
CURRENT, PROPERTY SIZE L4 , U11.05- ifr COVERED DECK.
CURRENT PROPERTY USE: QESIOANr,NL-
CURRENT SEPTIC USE: N/la SEWFe-
CURRENT WELL USE: U/A
IMPERVIOUS SURFACE AREA: 00N£
DECK: N/A
/ZOsIfr
1
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT or SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
O BOLTING °CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO
IS PUBLIC WATER AVAILABLE: ® YES ® NO
IF YES: ® COUNTY
® CITY
IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES CI NO PSSA: 0 ,YES 0 NO
DATE:
METHOD OF PAYMENT:
0
STAFF:
CASH CHECK
SANKCARD #,•
AUTHORIZED SIGNATURE*
WSA
• EXP/RES: VINA'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
S°akane
cogoValley
Mechanical Permit Application
11707 East Spregue Abenue, Suite 106 509-688-0036 - Phone
Spokane Valley,, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: X71 5 s- E. Vvkikzu gQz ti4 c, .
'�-'-i
PERMIT
USE:
OWNER `, %c QAC
5 OF UNITS
PHONE (Daytime Contact):
MAILING AD RESS: .
I2.-7 I c— 6 . SMArA)
4x,1444.4)E. v rtLE. (44 9G VC,
(street)
(city/state) I (ZIP)
CONTRACTOR D 0.4..) et_
•OR<100,000
LICENSE 1:
MAILING ADDRESS:
5AA/ � -
515
PHONE 1:
Sec / Cizz-tto
(street)
(city/state) , (ZIP)
METHOD OF PA
❑ CASH D C
DATE:
EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE-
DESCRIPTION OF WORK
5 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(ADDITIONAL FEE)
• OR<400,000
X
550
•
4
UNLISTED APPLIANCE (ADDmONAL 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/REFRIGERATION
1001 - 1750M BTU
X
557
-
11
BOILER/REFR10ERATION
+1750M BTU
X
595
•
12
GAS LOC, GAS INSERT, CAS FIREPLACE
-
1
X
510
la
-et,13
RANGE
-
X
510
-
14
DRYER
-
X
510
•
15
FUEL BURNING WATER HEATER
-
X
510
•
16
MRSC FUEL BURNING APPL
-
X
510
•
17
GAS PIPING (ea, Outlet)
-
X
51
-
18
DUCT SYSTEMS
-
4
X
510
• f a •CIU
19
VENTILATING FANS
-
X
510
•
20
AIR HANDLER (DOES NOT include dumng)
• OR< 10,000CFM
X
512
•
21
AUR HANDLER (DOES NOT include ducting)
>10,000CFM
X
519
•
22
EVAPORATIVE COOLERS
-
X
510
•
23
TYPE I HOOD
-
X
550
•
24
TYPE ll HOOD
-
X
510
•
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
•
26
AIRCONDITIONER
3.15 TON
X
520
•
27
AIRCONDITIONER
15.30 TON
X
525
•
28
AIR CONDITIONER
30-50TON
X
535
-
29
AMR CONDITIONER
•50 TON
X
560
-
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
510
32
WOOD STOVE - FREESTANDING
-
X
525
•
KENT -
Ma je,
111541
--
SUBTOTAL: 420.—
PLUS PROCESSING FEE: .*BIE
TOTAL PERMIT FEE DUE: W Z0, 00
DATE:
EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE-
N
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12715 EAST MAIN
SPOKANE VALLEY 1 WA
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