2004, 01-08 Permit App: BLD-04-03383 RemodelPERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:Tj,`(7,. M -t;
•ULLDING PERMIT
URELOCATION
a CHANGE IN USE •a GRADING D MANUFACTURED HOME
]-SIGN D TENANT Et OTHER...
OWNER / APPLICANT INFORMATION
OWNER: 1 1 C\CAL Pte- ® APPLICANT:
PHONE: L - a731 FAX: PHONE: FAX:
ADDRESS: -I 15 G7 Alp% vt�-' j�Q, �, ,t 'ADDRESS:
1 CITY,STATE, ZIP) CITY, STATE, ZIP
CONTRACTOR:
PHONE: FAX:
ADDRESS:
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE #
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT,OC..t,
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
OCCUPANCY GROUP: 2ND FLOOR SQ FT:
CONSTRUCTION TYPE:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME • SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF 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
CI BOLTING ®CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: CI YES 1 NO
IS PUBLIC WATER AVAILABLE: 0 YES a NO IF. YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: ® YES ® NO
IF YES: COUNTY ® CITY
1
DATE:
STAFF:
METHOD OF PAYMENT;
0 0
CASH CHECK
BANKCARD#; EXP/RES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
METHOD 0
0 CASH
DATE:
*dime
t!�
okane
.0.0Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT a
ADDRESS: 1/\) �r\ cv I-c\ue1 `.\_ Z �,.
PERMIT
USE:
DETAILS
OWNER: e ; camel \....._c• -.L.,
PHONE (Daytime Contact):
C C 3 2i 3\
MAILING ADDRESS:
913 -0, Nk r, ,AQ.
{:
\) 'e— L.��'A LO- � Up,
9 q 0 ‘, 9
(street) 1
{
(city/state) (ZIP)
$6
CONTRACTOR: /JCS
W
2
LICENSE #:
MAILING ADDRESS:
X
$6
PHONE #:
3
TUBS
(street)
t
(city/state) (GU') '
$6
PLUMBING FIXTURES
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
{
X
$6
-
W
2
URINALS
X
$6
-
3
TUBS
t
X
$6
-
W
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
-
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
1
X
$6
-
W
8
GARBAGE DISPOSAL
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
l
X
$6
-
SCJ
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH, CONDENSATE
X
$6
-
12
FOUNTAINS, DRINKING
X
$6
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
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
X
$6
-
I
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
-
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
86
-
PAYMENT
CHECK
VISA'
Wa..5
`
�.__.-____.
SUBTOTAL:
L
-7
PLUS PROCESSING FEE:
$35.00
■ ■
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
*lane
.,•i Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
METHOD OF PA
❑ CASH ❑ C
DESCRIPTION OF WORK
PROJECT
ADDRESS: 9R 3 /v, 1
X
PERMIT
USE:
a.k+esr,:A�i� Cl '
R: -TA ` 6, ! !, fl
J"�
ee
PHONE (Daytime Contact): CNS_ �-7 2 9
MAILING ADDRESS:
J
(street)
(city/state) )
(ZIP)
CONTRACTOR:
0.-`7
LICENSE #:
MAILING ADDRESS:
$19
PHONE #:
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
(street)
(city/state)
(ZJF)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER.:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
8 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR < 100,000
X
$15
=
2
FUEL BURNING APPLIANCE
> 100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR <400,000
X
S50
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
$100
=
5
USED APPLIANCE (WSEC min. AFUE rating)
= or <400,000
X
$50
=
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
$100
=
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
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
$10
=
13
RANGE
-
X
$10
=
14
DRYER
-
`
X
$10
=
10
15
FUEL BURNING WATER HEATER
-
X
$10
=
16
MISC FUEL BURNING APPL.
-
X
$10
-
17
GAS PIPING (ea. Outlet)
-
X
$1
=
18
DUCT SYSTEMS
-
X
$10
‘-?()
19
VENTILATING FANS
-
X
$10
=
20
AIR HANDLER (DOES NOT include ducting)
= OR < 10,000CFM
X
$12
21
AIR HANDLER (DOES NOT include ducting)
> 10,000 CFM
X
819
=
22
EVAPORATIVE COOLERS
-
X
$10
=
23
TYPE I HOOD
-
X
$50
=
24
TYPE II HOOD
-
t
X
810
-
10
25
HEAT PUMP/AIR CONDrTIONER
0-3 TON
X
$12
=
26
AIR CONDITIONER
3-15 TON
X
$20
=
27
AIR CONDITIONER
15-30 TON
X
$25
=
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
=
TIENT
MOM
SUBTOTAL:
40, .....
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER.:
AUTHORIZED SIGNATURE: