2004, 05-24 Permit App: BLD-04-04430 RemodelSpokane
,Walley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
.11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 'V// $ %77`f j R n o n
Assessor's Tax Parcel Number(s): Ga ) e' / "n -r
Legal Description:
PERMIT DESCRIPTION:
(Building Permit
�� Relocation
ta. rn n rle / FY ; Sr: r f
❑ Change in Use ❑ Grading
❑ Tenant Improvement ❑ Fire Safety
❑ Manufactured Home
❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner. ,(nand x,'SIrucfr
Phone: :co -373_ d�iy
Address: //s voom nyTon Are d7c6-
8rrmar To rz W{ 9'871 -hoot
City State Zip Code
111
Contractor:
Phone:
Address:
Fax:
City State Zip Code
WA State Contractor License #:
❑ Applicant: w€1, - ST/ u ek
Phone: sj q e i, 7 Fax:
Address: .a73/ S //rcya_
ccdx3ne &F _
CState Zip Code
Architect:
Phone:
Address:
Fax:
City
Contact:
State
Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
/7 '
DIMENSIONS:
.2 4/X,y /
# OF STORIES:
/
MAIN FLOOR TO SQ. FTG:
981/
2NU FLOOR SQ. FTG:
N4
UNFIN BASEMENT SQ. FTG:
Q
FINISHED BASEMENT SQ. FTG:
AM
GARAGE SQ. FTG:
DECKJCOV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
W coo ,-I a,.. -,t
HEAT SOURCE:
11e,7 pUmP
# OF BEDROOMS:
1
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT
30% SLOPES ON PROPERTY:
SEWER O N -SIT EPTIC
SYSTEM?
MANUFACTURED HOME
Width: Length: Year:
Manufacturer:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: DaterTime:
Valuation:
Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State
Inspector: Phone: Fax:
Address:
Zip
City
State
Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE
❑ REINFORCEMENT
❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
E Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
*lane
Project Address:
Owner: Phone (Daytime Contact):
Mailing Address:
Zip Code
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
Contractor:
Mailing Address:
License #:
City
•
State
Phone #:
Ci
State
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
#OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or fess than 100,000
X
515.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
519.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
550.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000 -
X
5100.00
=
5
USED APPLIANCE (WSEC min. AFUE
rating) -
Equal to or fess than 400,000
X
550.00
=
6
USED APPLIANCE (WSEC nun AFUE
rating)
More than 400,000
X
$100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
$15.00
8
BOILER/REFRIGERATION
101 - 500M BTU
X
528.00
=
9
BOILER/REFRIGERATION
501 - 1 000M BTU
X
539.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
11
BOILER/REFRIGERATION
More than 1 750M BTU
X
$95.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
X
510.00
=
13
RANGE
X
$10.00
=
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
X
510.00
=
16
MISC. FUEL BURNING APPLWNCE
X
510.00
=
17
GAS PIPING (each outlet)
X
51.00
=
18
DUCT SYSTEMS
X
510.00'
=
19
VENTILATING FANS
X
$10.00
=
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10 000 CFM
.
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
519.00
=
22
EVAPORATNE COOLERS
X
510.00
=
23
TYPE I HOOD
X
550.00
=
24
TYPE II HOOD
j
X
510.00 -.
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512.00
=
28
AIR CONDfTIONER
3-15 TON
X
52000
=
27
AIR CONDITIONER
1530 TON
X
$25.00
=
28
AIR CONDITIONER
30-50 TON
X
535.00
=
29
AIR CONDITIONER
- More than 50 TON
X
$60.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
510.00
=
32
WOOD STOVE - FREESTANDING
X
525.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
$35.00
EXPIRES
TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Zip Code
Sp crane
//Valley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildngDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
Contractor: License #:
Mailing Address:
City
State
Phone #:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
-
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
I
X
58.00
=
2
URINALS
X
56.00
=
3
TUBS
'
X
58.00
=
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
56.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
/)
L
X
$6.00
=
PREP/CULINARY/MEAT
6
DISHWASHER
1
X
56.00
=
7
CLOTHES WASHER
,
X
56.00
=
8
GARBAGE DISPOSAL
X
56.00
=
9
WATER SOFTENER
X
58.00
=
10
ELECTRIC HOT WATER TANK
NOTE IF GAS, SEE MECHANICAL
1
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
56.00
=
12
ROOF DRAINS/OVERFLOW DRAINS
X
58.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
- GRINDER, SUMP PUMP
. X
58.00
=
18
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
I
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D_ FOR
VATS TANKS, BOILERS
X
58.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
56.00
=
METHOD OF PAYMENT: -
0 CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: ' EXPIRES:
SUBTOTAL
PROCESSING FEE
535.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
szi2!s•2ais-rza Jo nzv
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4»J .,-lobt4ining a-building-pernit arirlthe-tifeardi Urea —I--7
. . . : representation of the proposal! All knoteno_roperty_
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