2004, 07-09 Permit App: BLD-04-07046 ResidencePERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LO/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509 688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREETAODRESS: 170/'1 5 •� / 'a i:22t V��Q
JL_D
ASSESSOR'S TAX PARCEL NUMBER(S): �" / ! J ,2(1/7/7 U
0-r 6LK
iP)L, t?DGC RIDG.t -Pt D
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
UILDING PERMIT
ThRELOCATION
CiCIIANGE.INUSE- DGRADING .-.-.-.0MANUFACTURSDHOME
l SIGN ' 0 TENANT l] OTHER
OWNER / APPLICANT INFORMATION
® OWNER:
PHONE: FAX:
ADDRESS:
CONTRALTO
PHONE(
ADDRESS:
CITY,ST • E, ZIP
4
/
epi � FAX: 9
, TATE, ZIP
WA ST CONTRACTOR LICENSE
L�Y1JJl-i.r_6 2,5.-- rA
APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
113 ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT: ..
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
30% SLOPES ON PROPERTY: /40
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:
In "
BUILDING DIMENSIONS: %tl W CONSTRUCTION TYPE:
NUMBER OF STORIES:4 Li Q L- STRUCTURES ON PROPERTY: 0
NUMBER of BEDROOMS: J
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
CRITICAL AREAS: /
CURRENT PROPERTY SIZE: /O•i�%
CURRENT PROPERTY USE:_V1t- -.-
CURRENT SEPTIC USE: JI //ft
/U7 '1—
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: S0J4
1
MAIN FLOOR SQ FT: 3 U `-'
s22
2N0 FLOOR SQ FT: ,Jl
UNFIN BASEMENT:
FINISHED BASEMENT
GARAGE:
COVERED DECK:
•BEAK:
1
MANUFACTURED HOME
SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
NT SET:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
1
PLANS EXAMINER:
ADDRESS:
f -HONE:
FAX:
INSPEC 1OR: PHONE:
ADDRESS:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
❑ BOLTING CI CONCRETE ❑ REINFORCEMENT
FIRM NAME:
PHONE: FAX:
❑ WELDING
INSPECTOR(S):
1
BUILDING STAFF USE ONLY
'1
• IS PUBLIC SEWER AVAILABLE: ❑ YES El NO IF YES: 0 COUNTY ❑CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 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: ❑ YES ❑ NO PSSA: 0 YES 0 NO
METHOD OF PAYMENT:
0 0
CASH CHECK
BANKCARDA;•
AUTHORIZED SIGNATUR
*FAXEDPERMITAPPUCAAONS_WILLONLY BE ACCEPTED WITH MAJOR BANKCARD
RELOCATION FIRE SAFETY
- = FIRE -ALARM:
PREVIOUS ADDRESS:
FIRE SPRINKLER: II
BOOTH: TENT:
PAINT _'
FIREWORKS DISPLAY:
PROPOSED USE:
DATE/TIME:
BLASTING':
Q.
WA STATE NON-RESIDENTtAL ENERGY CODE
1
PLANS EXAMINER:
ADDRESS:
f -HONE:
FAX:
INSPEC 1OR: PHONE:
ADDRESS:
CITY, STATE, ZIP
FAX:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
❑ BOLTING CI CONCRETE ❑ REINFORCEMENT
FIRM NAME:
PHONE: FAX:
❑ WELDING
INSPECTOR(S):
1
BUILDING STAFF USE ONLY
'1
• IS PUBLIC SEWER AVAILABLE: ❑ YES El NO IF YES: 0 COUNTY ❑CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 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: ❑ YES ❑ NO PSSA: 0 YES 0 NO
METHOD OF PAYMENT:
0 0
CASH CHECK
BANKCARDA;•
AUTHORIZED SIGNATUR
*FAXEDPERMITAPPUCAAONS_WILLONLY BE ACCEPTED WITH MAJOR BANKCARD
Sptikan e
a:tossValley
LUMBING PERMIT APPLICATION
:o s: 37I)'T
Ty►(
.. . -, - DETAILS_ : __ _:
USE: 1
X .
OWNER:
-
' AMOUNT.
PHONE (Daytime Contact):
TOILETS -
MAILING ADDRESS:
0)
X
$6
(street)
jcity/state)
(zip)
C •CTOR: ...
WE
,//)
1, t/ f�,
' XJ
LICENSE
''J//
11n'i�'YJI.J
Q� j�
R� I tin
MAI, ADDRESS:
17t A. Ther—
EHONE #:&,�
J/JJ•
40 7q
fl, ,
IV/4P
(street)
$6
(city/state)
(zip)
UMBINGFIXTURES
DATE:
BANKCARD NUMBER:, AUTHORIZED SIGNATURE:
DESCRIPTION
.. . -, - DETAILS_ : __ _:
it of UNITS
X .
. COS/
_. EQUALS
' AMOUNT.
1
TOILETS -
WATER CLOSET, BIDETS
0)
X
$6
c
2
URINALS
X
56
3
TUBS
X
$6
4
SHOWERS (PER TRAP) :
BATH, STALL, ON-SITE BUILT
X
$6
'
5
SINKS
LAVSBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, U IIIJTY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6
=
6
DISHWASHER
X
36
=
7
CLOTHES WASHER
/
X
$6
=
8
GARBAGE DISPOSAL
/
X
$6
=
9
WATER SOFTENER
X
$6
=
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
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 ANO/OR COFFEE MAKER,
X
$6
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
16
17
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
s
SPRINKLER SYSTEM
/
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56
e
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
a
20
MISC PLUMBING FIXTURE
X
$6
-
SUBTOTAL
visor ,uai C.
❑.,..,4-
PLUS PROCESSING
FEE
$35.00
❑ CASH ■ CHECK. El
FAXED PERMITS
WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE:
BANKCARD NUMBER:, AUTHORIZED SIGNATURE:
Spoka�n' ne
\M ley
MECHANICAL PE MIT APPLICATION
PROJECT /�/,�` n
ADDRESS: b, I
/
if
r / I /1 �L1i1��Ll�1l. J
I ' ,l_
USERMR
OWNER
COST
EQUALS
AMOUNT
PHONE (Daytime Contact):
MAIUNG ADDRESS:
- OR000,000
X
315
-
(street) _city/state)
••((zzip))
CONTRP�2F f �//%��
_"
- _:>100;000—t
, - - - .
E
J��} ' l
6A'R — :' /G'C]VLU
MAILING ADd SS:
•:" _
.• • • •. .- .
-
3
PHONE C: ;
=0R<400,000
X
350
e
(street) (city/state) (zip)
1
DESCRIPTION OF WORK
seFWM
1
COST
EQUALS
AMOUNT
.
FUEL BURNING APPUANCE
- OR000,000
X
315
-
2
FUEL BURNING APPLIANCE . -- _--
- _:>100;000—t
--
X
: -..$19
•:" _
.• • • •. .- .
-
3
UNUSTED APPUANCE (ADDITIONAL FEE)
=0R<400,000
X
350
e
.4
UNLISTED APPU At4CESADDMONAL FEE)
>400,000
X
3100
-
5
USED APPUANCE(WSEC min. AFUE rating)
=0R400,000
X
. $50
-
6
USED APPUANCE(WSEC mot AFUE rating)
>400,000
X
$100
-
7
BOILER/REFRIGERATION
1-100M BTU
X
315
-
8
BOILER/REFRIGERATION .. ..
-101500M BTU-
-
X9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
-
10
BOILER/REFRIGERATION
1001-1,750M BTU
X
357
=
11
BOLER/REFRIGERATION
+1750M BTU
X
395
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
- -
/ .,
X
X
310
310
=
-
-
13
RANGE ... ----
14
DRYER
-
X
310
=
15
FUEL BURNING WATER HEATER
-
)
/
X
310
=
16
MISCELLANEOUS FUEL BURNING APPL
-X
310
=
17
GAS PIPING (ea. Outlet)_
-
S
X
51
=
18
DUCT SYSTEMS
-
.—
X
310
=
19
VENTILATING FANS4.
-
X
310
=
20
AIR HANDLER (DOES NOT Include ducting)
=OR<10,000CFM
X
- 312
=
21
AIR HANDLER (DOES NOT Include ducting)
>10,000CFM
X
319
-
22
EVAPORATNE COOLERS
-
X
$10
=
23
TYPE IHOOD'
X
$50
12
24
TYPE U HOOD
-
/
X
310
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
. 312
-
26
AIR CONDITIONER
3-15 TON
/
X
$20
-
27
AIR CONDITIONER
15-30 TON
X
$25
-
28
AIR CONDITIONER
30-50 TON
X
335
-
29
AIR CONDITIONER
+50TON
X
$60
e
30
LPG STORAGE TANK-
•
X
. ";.">_ . $10
-- •
•
31
WOOD OR PELLET STOVE/INSERT-
X
310
=
32
WOOD STOVE - FREE STANDING-
-
X
- $25
.. • a
'•
CASH 0 CHECK 0 •
FAXED PERMITS WL ONLY BE ACCEPTED
OF A MAJOR CREDIT
EXPIRES
EXPIRES
SUBTOTAL
t;y
...1-''
M
PLUS PROCESSING
FEE
$35.00
DATE:
WITH PAYMNI;
CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER: C
AUTHORIZED SIGNATURE:
)�I
C2 4
/J
50' to ctr. of culdesac
from property line
14
Easement
b
25' Bldg
Setbock
0
10
Elec. `,
. o - Is beteg submitted for the propose of
obtaining a building wont end is a true and correct
representation of the proposal. All known
property
linesld ons. curb lines. structures
and easements
Mined. Also
steep stapes
.5 C ADDRESS.f Q . Me Qoviaert o° .
ZONE Win! Gam! ' I1
FRONT 'S9/7' FLANKING AS 3 ((
COMMENTS
REVIEWED BY
have •t
bod
Signed:
20
40
SEPTEMBER 2003
M
-J
we .islands.
critical areas.
y�0./or
9
1 S NICDotiat�
PINE ROCK RIDGE 1ST ADDITION
LOT 8 BLOCK 6
Founded 1946
impson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
PHONE (509) 926-1322 FAX (509) 926-1323