2003, 10-27 Permit App: BLD-03-02905 Residence1
1
Spokane
Malley
PERMIT 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: (/'7 / f 2
V I ,
ASSESSOR'S TAX PARCE NU BER(S):
XPi 6:ef__Kff _2
DESCRIPTION: �2et--r R
LEGAL DISCRIPTION:
PERMS
UILDING PERMIT 0 CHANGE IN USE Q GRADING ❑ MANUFACTURED HOME
DOIHER
®RELOCATION DSIGN ()TENANT
OWNER / APPLICANT INFORMATION
® OWNER:
PHONE:
ADDRESS:
Ci CONTRACT
PHONE
ADDRESS.
FAX:
nc9) ESTATE, ZIP
WA ST CONTRACTOR LICENSE # 1�
D APPLICANT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
Q
ARCHITECT.:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:/OCCUPANCY GROUP:
BUILDING DIMENSIONS!] / /V A o CONSTRUCTION TYPE:
NUMBER OF STORIES: / STRUCTURES ON PROPERTY:..'
NUMBER of BEDROOMS: 3 CRITICAL AREAS:
FLANKING SETBACK:((�� CURRENT PROPERTY SIZE:g7L/
FRONT SETBACK: /7IJ CURRENT PROPERTY USE: U ut
REAR SETBACK: '11 q /
LEFT SETBACK: e� CURRENT WELL USE: / V/
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: -123-4.3
30% SLOPES ON PROPERTY: Ald
CURRENT SEPTIC USE: A
MAIN FLOOR SQ FT: 657c
2N0 FLOOR SQ FT:
UNFIN BASEMENT:_ "�
FINISHED BAS22EMMyENTJ.T.-7F�
GARAGE: (J 15
COVERED DECK:
DECK:
MANUFACTURED HOME SIGN
WIDTH:
YEAR:
MANUFACTURER:
LENGTH:
PIT SET:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRGALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
BLASTING:
DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE:
ADDRESS:
-FAA:'
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
0 BOLTING
FIRM NAME:
INSPECTOR(S): Y
°CONCRETE
0 REINFORCEMENT
PHONE:
0 WELDING
"FAX:
BUILDING STAFF USE ONLY
• IS PUBLIC SEWER AVAILABLE: 0 YES 0 NC)
IS PUBLIC WATER AVAILABLE: YES NO
IF YES: ® COUNTY CITY
IF YES, WHICH WATER DISTIIRR:
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
1
DATE:
1
METHOD OF PAYMENT:
STAFF:
O O 0
CASH CHECK
VISA
BANKCARD A;• EXPIRES: VIN#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Spokane
e`'''
le'
MEIANICAL PER APPLICATION
PROJECT jt N I or A , )n/1e
ADDRESS: ,✓/Y f I r Ili _
PERMIT
USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
COST
(street) (city/state) • (zip)
GO f GTS:
1
LY j-F-e;N-11- - /O69 tau )
MAILING atES :
�oiq . o � i
PHONE #:-7 } ( _ / r0
—L)'I3
07
(street) (city/state) (zip)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
x of wars
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
= OR<100,000
/
X
315
=
2
FUEL BURNING APPLIANCE
>100,000
X
$19
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
=0R400,000
X
$50
- =
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
>400,000
X
$100
=
5
USED APPLIANCE(WSEC min. AFUE rating)
=0R<400,000
X
$50
=
6
USED APPLIANCE(WSEC min. AFUE rating)
>400,000
X
$100
=
7
BOILER/REFRIGERATION
1-100M BTU
X
515
=
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
557
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG GAS INSERT, GAS FIREPLACE
-
.,
X
510
=
13
RANGE
i
X
$10
=
14
DRYER-
/
=
X
$10
=
15
FUEL BURNING WATER HEATER
-
/
X
510
16
MISCELLANEOUS FUEL BURNING APPL-
X
310
=
17
GAS PIPING (ea. Outlet)
-
X
51
=
18
DUCT SYSTEMS-
X
$10
=
19
VENTILATING FANS
-
,5-
x
$10
=
20
AIR HANDLER (DOES NOT include ducting)
=OR<10,000CFM
X
312
=
21
AIR HANDLER (DOES NOT Include ducting)
>10,000CFM
X
$19
=
22
EVAPORATIVE COOLERS'
- - - - - -
X
$10
=
23
TYPE I HOOD
-
X
$50
=
24
TYPE II HOOD
-
/
X
$10
=
25
HEAT PUMP/AIR CONDITIONER
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
+50TON
X
$60
=
30
LPG STORAGE TANK-
X
$10
=
31
WOOD OR PELLET STOVE/INSERT-
X
510
=
32
WOOD STOVE - FREE STANDING
-
X
525
=
--`
I
-
SUBTOTAL
P
' -
mi CASH II CHECK ■ •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS WILL ONLY BE ACCEPTED
OF A MAJOR CAEDff
neTr, . / cvom
'WITH PAYMENT
CARD
\
\oc. ` 1
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
*Wane
ne
.000Valley
PLUMBING PERMIT APPLICATION
PROJECT 3qJ 9 /, me j1 L// /f y
ADDRESS: c 'l/ Ali N✓I IN/1Lh�� y/�[,�i
PERMIT
USE:
DETAILS
OWNER:
X
PHONE (Daytime Contact):
EQUALS
MAILING
ADDRESS:
TOILETS
WATER CLOSET, BIDETS
'%
(street) (city/state)
(zip)
MA
RACTOR: "'I
�/�
LICENSE #:
ADDRESS: 4
X
P •NE#:3& —
/
D ��
3
TUBS
(street) (city/state)
(zip)
PLUMBING FIXTURES
DATE:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
#OFa m
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
'%
X
56
=
2
URINALS
X
56
=
3
TUBS
41
X
$6
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
56
6
DISHWASHER
/
X
$6
=
7
CLOTHES WASHER
/
X
$6
=
8
GARBAGE DISPOSAL
/
X
56
=
9
WATER SOFTENER
X
$6
=
10
ELEC HOT WATER TANK
NOTE: IF GAS SEE MECHANICAL
X
56
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
/56
X
=
12
FOUNTAINS, DRINKING
X
56
=
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,
GARBONATOR, SWAMP COOLER
3
X
$6
-
16
CROSS CONNECTION
DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, SUMPS, TANKS, BOILERS
X
$6
=
17
SPRINKLER SYSTEM
/
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$e
_
19
MEDICAL GAS perDrutiet
NITROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE
X
$6
=
-
=r:
vaa Matte,:
a 0 _-Fart
SUBTOTAL
III
CASH 0 CHECK •
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
WILL ONLY BE ACCEPTED WITH PAYMENT
OF A MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
\
25' Bidg
Setback
, \
14 ` 14' Utility
7 t, / \\Easement
7
1 \
,
` \
1 \
,
\
1 11'
\
1
0
10
9
12
` -eteci..-F. _.
d
1 \
drivewa%y \ 00
ro
1
281—t \.4 x
1
sewer
I
1 I
• 1
I I
II , water
10
0 0
\ t
1'
47'
5' 125 06'
APPROVED Bxiticitct_
3719 S. McDonald Lexington Homes
PINE ROCK RIDGE 1ST ADDITION
20
40
SEPTEMBER 2003
LOT 10 BLOCK 6
Founded 1946
2mpson Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
PHONE (509) 926-1322 FAX (509) 926-1323