2003, 11-20 Permit App: BLD-03-03124 Residence*laneaosi�
galley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (5091668-0036 Five:509r666-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: , S7 13 5 iY Donl AL D
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL OISCRIPTION:
l_nT q
PER
DESCRIPTION:
bLK (n PIAIE RGcK D6 -ET
4634 5. clic)
DEWING PERMIT (1 CHANGE IN USE 0 GRADING O MANI:1F I UKZD HOME
[}OTHER
RELOCATION ° SIGN O TENANT
OWNER / APPLICANT INFORMATION
CI OWNER:
PHONE: FAX:
ADDRESS:
O CONTRACTO
PHON
ADDRESS:
APPUCANT:
PHONE: FAX:
ADDRESS:
XTATE, ZIP
WA ST CONTRACTOR UCENSE vJ ffr to
CITY, STATE, ZIP
PHONE: FAX
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK: /-
BUILDING DIMENSIONS i✓ )( 6"
NUMBER OF STORIES: 1
NUMBER of BEDROOMS: A
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK: 4/ -
LEFT
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY: /
CRITICAL AREAS:
N0
CURRENT PROPERTY SIZE V v
CURRENT PROPERTY USE: \././
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: /857c
2N, FLOOR SQ FT:
UNFIN BASEMENT: /
FINISHED BASEMENT*
GARAGE: I
COVERED DECK:
DECK:
a � D
6omtat 2%
Spokane
.000Valley
MBING PERMIT APPLICATION
c4 17°
c/,-7 0
ADOJECTS: 3/
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ADDRES
// I �/1n
eI�
PERMIT
USE:
`
OWNER
X
X
PHONE (Daytime Contact):
MAIUNG ADDRESS:
' AMOUNT
•
1
TOILETS
(street)
2
(city/state) (zip)
C
CIOR
/ t/) /
/•LICENSE#:
st
�„n,^
MAI
/
ADDRESS:
%G
/1
fn
—
X
ONE #: .
l80R? - 4D 7 f
I`�R%lP
(street)
SHOWERS (PER TRAP)
e
(city/state) (zip)
DESr'RIPTIOi:
DETAILS
#oFomits
LV
X
X
COST
$6
EQUALS.
.
' AMOUNT
•
1
TOILETS
WATER CLOSET, BIDETS
2
URINALS
X
56
st
3
TUBS
X
56
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
/V//1
X
$6
.
6
DISHWASHER
/
X
- 56
-
7
8
CLOTHES WASHER
/
X
$6
GARBAGE DISPOSAL
/ -
X
$6
•
8
WATER SOFTENER
X
56
sx
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
$6
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
/
X
56
=
12
FOUNTAINS, DRINKING
X
56
=
13
WATER PIPING/DRAIN-IN
WASTE, VENT,
PLUMBING REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
56
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X-
56
•
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER.
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
' 3
X
56
.
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR
VATS, SUMPS, TANKS, BOILERS
X
56
.
17
SPRINKLER SYSTEM
/
X
525
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6
a
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
56
20
MISC PLUMBING FIXTURE
X
56
-
MN ❑
Was ONLY BE ACCEPTED
OF A MAjORCRPDIT
SUBTOTAL
R
_get
PLUS PROCESSING
FEE
$35.00
• CASH • cn scLc ❑
PAXPD PERMITS
WITH PAYMEM
CARD
TOTAL PERMIT FEE
DUE
Sik)lan ems"'
Valley,
ECHANICAL PERMIT APPLICATION
PROJECT . /3 71 /� , / ,
ADDRESS: I 3)
e (l( „_ a
( tom` �i{/.ij"(i
USEMIT
,i7.
OWNER:
X
COST
PHONE (Daytime Contact):
MAIUNG ADDRESS:
1
FUEL BURNING APPLIANCE
= OR<100,000
(street)
(ciitty/ss$tate)) •
CONiRF,Z�f f : /�
j
/� n%
s.ewer-
20
APPROVED BY
3713 S.McDonald Lexington Homes
SEPTEMBER 2003
PINE ROCK RIDGE 1ST ADDITION
LOT 9 BLOCK 6
tbitimpson Engineers, Inc.
Founded 1946
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
PHONE (509) 926-1322 FAX (509) 926-1323