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2003, 09-17 Permit App: BLD-03-02485 Residenceso/Valley ' 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: /NO E. ` NO7/ 1 , I/ ASSESSOR'S TAX PARCEL NUMBER(S): //�� 1� V� yy'�/'4 G (/�„ �L LEGALDISCRIPTION: L 13 r2 oT mi6,5 L// V /411-7_5 hz%7 PERMIT DESCRIPTION: BUILDING PERMIT 0 CHANGE IN USE ® GRADING LOCATION Q SIGN Q TENANT ® MANUFACTURED ROME Q OTHER ' OWNER / APPLICANT INFORMATION ® OWNER: W$I 1 16-rOyU j-tt n 65APPLICANT: 'Diet PHONE: /! - ✓ G FAX:I /O9D:JQ® PHONE: FAX ADDRESS: i0 40cf /71-/ f 6' 3K4lij6' Rldg-Ess: CITY,STATE, ZIP CITY, STATE, ZIP ®CONTRACTOR: LEX l J (7I071.1 [+CiT%I&5 ® ARCHITECT: PHONE: ADDRESS: FAX: PHONE: ADDRESS: [54016- CITY,,STATE, ZIP ion WA ST CONTRACTOR LICENSE /I t £$ IN 1' (0a5cT>4 FAX: CITY, STATE, ZIP CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: /. U tTU 30% SLOPES ON PROPERTY: NO BUILDING HEIGHT TO PEAK)' 71' OCCUPANCY GROUP: BUILDING DIMENSIONS:/ $ 50'47//CONSTRUCTION TYPE: NUMBER OF STORIES: STRUCTURES ON PROPERTY: NUMBER of BEDROOMS: FLANKING SETBACK: FRONT SETBACK: 3 CRITICAL AREAS: MAIN FLOOR SQ FT: /I 1 2ND FLOOR SQ FT: UNFIN BASEMENT: )//�� FINISHED BASEMENT: /UV 9 GARAGE: 521/ CURRENT PROPERTY SIZE:© V v V 5 F COVERED DECK: t�L'lv CURRENT PROPERTY USE: i / ECK: 1 REAR SETBACK: 5&.CURRENT SEPTIC USE: -Thr /mo/i LEFT SETBACK: / 9' 5 CURRENT WELL USE: /� /Lf g$F RIGHT SETBACK: L/ IMPERVIOUSSURFACE AREAL l oU 1 MANUFACTURED HOME SIGN WIDTH: LENGTH: YEAR: PIT SET: MANUFACTURER: SQ FT OF SI9N: HEIGHT OF SIGN: # OF SIGNS: AREA OF EXIST SIGN: TYPE OF SIGN: RELOCATION FIRE SAFETY PREVIOUS ADDRESS: PROPOSED USE: FIRE SPRINKLER: PAINT BOOTH: FIREWORKS DISPLAY: FIRE ALARM: TENT: BLASTING: DATE/TIME: WA STATE NON-RESIDENTIAL ENERGY CODE PLANS EXAMINER: PHONE: FAX: ADDRESS: CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY, STATE, ZIP SPECIAL INSPECTIONS O BOLTING FIRM NAME: INSPECTOR(S): ®CONCRETE ® REINFORCEMENT PHONE: CI' WELDING FAX: BUILDING STAFF USE ONLY 1 IS PUBLIC SEWER AVAILABLE: ® YES CI NO IS PUBLIC WATER AVAILABLE: ▪ YES 0 NO IF YES: ® COUNTY ® CITY IF YES, WHICH WATER DIST/IRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES ❑ NO DATE: STAFF: METHOD OFPAYMENT.- O 0 CASH CHECK SANKCARD #: AUTHOR/ZED S/GNATUR VISA EXPIRES: V/N# *FAXED PERMIT AP ONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD Spy k ea MECHANICAL PERMIT APPLICATION PROJECT lO (L? r • /� R ADDRESS: I v I (� DESCRIPTION OF WORK MIT USE: # OF UNITS OWNER: 1 F , ! ✓11/„ �Inl1 „\1l m 65 COST PHONE (Daytime Contact): i3 % —/61 y •MNLINGADD ESS' / 9/3$ I I7 %, a(�(/l`A—Al C� �I�� X V (street) s� (city/state) • (zip) C 3ACTJ.)R: napri1V(i FUEL BURNING APPLIAN'E :1 WE /V 1316 IvIATINNG ADDRESS: �I D I q Gi✓ N r� r i� 5490 __ PHONE #:, #464. /L/O }�-- : ei4AJJ G .c/R07 =0R<400,000 (street) (city/state) (zip) BANKCARD NUMBER: AUTHORIZED SIGNA DESCRIPTION OF WORK # OF UNITS X COST EOUALS AMOUNT 1 FUEL BURNING APPLIANCE = OR<100,000 / X 515 = 2 FUEL BURNING APPLIAN'E :1 >100,000 X 519 = 3 UNLISTED APPLIANCE (ADDITIONAL FEE) =0R<400,000 X 550 = 4 UNLISTED APPLIANCE (ADDRIONAL FEE) >400,000 X 5100 = 5 USED APPLIANCE(WSEC min. AFUE rating) =OR<400,000 - X 550 = 6 USED APPLIANCE(WSEC min. AFUE rating) >400,000 X 5100 = 7 BOILER/REFRIGERATION 1-100M BTU X 515 = 8 BOILER/REFRIGERATION 101-500M BTU X $28 = 9 BOILER/REFRIGERATION 501-1,000M BTU X 339 = 10 BOILER/REFRIGERATION 1001-1,750M BTU X 357 = 11 BOILER/REFRIGERATION +1750M BTU X 595 = 12 GAS LOG, GAS INSERT, GAS FIREPLACE - ., f X X 510 $10 = = 13 RANGE- 14 DRYER - X 510 _ 15 FUEL BURNING WATER HEATER - X $10 = 16 MISCELLANEOUS FUEL BURNING APPL- X $10 = 17 GAS PIPING (ea. Outlet) - y� '.J X 51 = 18 DUCT SYSTEMS - X 510 = 19 VENTILATING FANS- X 510 = 20 AIR HANDLER (DOES NOT include ducting) =OR<10,000CFM X 512 = 21 AIR HANDLER (DOES NOT Include ducting) >10,000CFM X $19 = 22 EVAPORATIVE COOLERS- X 510 23 TYPE I HOOD - X 550 = 24 TYPE II HOOD - / X 510 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X . 512 = 26 AIR CONDITIONER 3-15 TON X $20 = 27 AIR CONDITIONER 15-30 TON X 525 = 28 AIR CONDITIONER 30-50 TON X 535 = 29 AIR CONDITIONER +50TON X $60 = 30 LPG STORAGE TANK- X $10 = 31 WOOD OR PELLET STOVEANSERT- X , $10 = 32 WOOD STOVE - FREE STANDING - X $25 = - - SUBTOTAL - ' -- WITH PAYA4Nf CARD ■ CASH 0 CHECK • a. ■ PLUS PROCESSING FEE $35.00 FAXED PERMITS WILL ONLY BE ACCEPTED OF A MAJORCREDIT TOTAL PERMIT FEE DUE BANKCARD NUMBER: AUTHORIZED SIGNA Spbrkannee ley 1 PROJECT ADDRESS: DESCRIPTION j- PERMIT USE: rI OWNER: V �- 0 ET PHONE (Daylime�Co"ntact): 9.9),../.— Cyei MAILING ADDRESS: 1 �}y- 0 <�C k 14 / —No t..\-- C.i ( treet) 1 Jcity/state) (zip) CO CTOR: ) s Qumeint-mm� LICENSE #: a®- MAIUNG ADDRESS, 11 ba 3. m A sp- 59064N � 2ti07c E- q9a/ v (street) (city/state) (zip) DATE: EXPIRES: DESCRIPTION DETAILS a OF UNITS X COST EQUALS AMOUNT 1 TOILETS - WATER CLOSET, BIDETS � X $6 = 2 URINALS X 36 = 3 TUBS / X 36 = 4 SHOWERS (PER TRAP) BATH, STALL, ONSITE BUILT / X 36 = 5 SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN. LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY/MEAT , 1 K X 36 = 6 DISHWASHER / X 36 7 CLOTHES WASHER I X $6 8 GARBAGE DISPOSAL / -- X $6 9 WATER SOFTENER X 36 10 ELEC HOT WATER TANK NOTE: IF GAS SEE MECHANICAL X 16 = 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE / X 36 = 12 FOUNTAINS, DRINKING X 36 = 13 WATER PIPING/DRAIN-IN WASTE. VENT, PLUMBING REVERSAL INSTALLATION, ALTERATION, REPAIR, REVERSALS X 36 = 14 SEWAGE EJECTOR GRINDER, SUMP PUMP X 36 = 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, HOSE BIB, STEAMER, PROOFER, CARBONATOR, SWAMP COOLER 3 X 36 = 16 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR VATS, SUMPS, TANKS, BOILERS X 16 = 17 SPRINKLER SYSTEM / X 325 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X 36 _ 19 MEDICAL GAS per outlet NITROUS, OXYGEN X 36 = 20 MISC PLUMBING FIXTURE X S6 = ID - SUBTOTAL • "3. CASH • CHECK ❑ .w. • PLUS PROCESSING FEE $35.00 FAXED PERMITS HILL ONLY BE ACCEPTED WTIF- PAYMENT OF A MAJOR. CREDIT CARD TOTAL PERMIT FEE DUE DATE: EXPIRES: s Spo"kan �V 11ey Call 24 hours before inspection required 'Call 509.688-0036 Fax 509.688-0037 DEPARTMENT OF PUBLIC WORKS Anticipated start date 67 /03 Permit # PW 03 — 437 APPROACH PERMIT o� (Addres arcel #, if ava a.le Applicant Na s�tja+w .' dayy Ld _S' ' Address III + �/one Ph APPLICATION Location of prope Contractor's Name Address Azivink- Phone Contractor's Reg#L"P) N IO9 Expires `t"/% 704 PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Existing Curb & Gutter Culvert Installation Other conditions Commercial/Industrial Driveway Rural Road Section Sidewalk Repair/Construction See construction requirements and details on reverse. Bond/insurance certification must be on file with the City. SPECIAL CONDITIONS: PERMIT FEE $ Inspection Fee$ I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card. Card # Expiration Date Name of Holder Signature Fees Paid$ Date Init MIRY 27 2003 10:44 FN to d941md r.162/U3 CITY OF SPOKANE VALLEY DEPARTMENT OF PUBLIC WORKS 11707 EAST SPRAGUE AVENUE SPOKANE VALLEY, WA 99206 (509) 921-1000 SWALE LOT PLAN AGREEMENT In consideration of the issuance of a building permit for Lot (.6--), Block ( I Spokane Valley file number ( ): The Applicant has deposited $1,000 with City of Spokane Valley Public Works Department as security for full and faithful performance by Applicant respecting the drainage swale/ditch system, sod and performance and other work as is incidental and related thereto in accordance with the accepted Swale Lot Plans and specifications as submitted to and accepted by the City of Spokane Valley Public Works Department. The Applicant shall request or cause to be requested a final inspection of the drainage swale/ditch system, sod and performance, by City of Spokane Valley Public Works. The applicant shall perform a field test of the drainage swale/ditch system, sod and performance, by flooding the swale to the design volume of the accepted Swale Lot Plans, in the presence of a City of Spokane Valley Inspector. If the drainage swale/ditch system, sod and perfcrmance, conforms to the accepted Swale Lot Plans of file with the City of Spokane Valley, and performs as designed in the field test, the Public Works Department shall release the deposit back to the Applicant The Applicant hereby agrees that should the drainage swale/ditch system, sod and performance, not be constructed in accordance with the accepted Swale Lot Plans and/or fail to pass a field test within six months of final inspection approval by the Public Works Department, the deposit shall be forfeited to the City of Spokane Valley Public Works Department. The City of Spokane Valley may use the monies forfeited to bring the drainage swale/ditch system, sod and performance and other work as is incidental and related thereto into compliance with the accepted Swale Lot Plans on file. The Applicant shall also agree to be responsible for any cost incurred by the City in bringing the drainage swale/ditch system, sod and performance into compliance withe accepted plan , which are in excess�/ideposit. Dated this 11�j1 6aY of 20 Monies to be retumed to: NAME OT Address ,IT/1 City, State Phone Signed MP�NY��I/� �.d 4244' 4.i<<Iewag SEP 16 2003 10:04AM SPOKANE COUNTY 09/15/2003 09:15 5098 921206V LEX INGIUN HUMt77 7179 ATM : ^ •� PAUL b . 1 • APR 1 B 2003 1 Z: 57PM , SRO WINE COUN7y-yp?�.^•;%. • >::,., ,in;..477-.717e•esti,n,,; ;1,V 2. ? >,2 : an1!re vt et�+r ttyri x1G Rglgap1141,4*rIUNFORM. PL8A56NOTEr ME"%Ac ionhvmmostbeMauis" ...r;. • .. _ dste nrpermva%revalidfor12nadalame&Asaf aoeiresri:tie.:be gonad. Perms* tgto•:• ltibo . No ez4mtimwan'O be gonad. ✓'a7'wpafomedm arbem l5eno®tp eft. .". •.A"+dTprba9eb'-%^•'.''• PRP • INPORMA'170N .• !".i .�: - ....y •..r^' •n'.Y: job Mikan I tg Papal Nainkon e./ :_ 4ns L.o Q „ Riorl: , �°eajs [..t• XI N6 -WA) �/YI ss4 . ProjectName m _ (o Aalut r�-�'! f )3N -` f, /)115 10 P4)uf— . ymrsr•.7eagp C mmceai0 TemJxP- ti orary 1© S% Regular 'O Dry Sewer O Repair O Addition O A.b ndonmc r • New O New Carnet=./0 a - •qac ��s�9---- • MUT TUC D7Y1S10 pCREMEoWNPnnitf asimraff8 Ai7A7IOri d1►SrAn.4FCONfA+ tHt flflg73) CAN BE rSSun. O$ to %aka Seaz.yeRmCr. CPICInt p *MATVdT TnTG1'fIESDAMONPERSON CONT , !a•_, 4 .et._ 4 cylitmrax'cia vA 1-Hwy— Arisen addratY_-y.� //n'//jJ aryaris hiDR( FF INTBRInu � GAlcTIONrarS2( MeOtte ' - i:oarraaee (if ale rein from; 'Lowe): Piaooc Business Ma . coy/sots/4, 0 .� PEE7NPOREfATION . ^ neea see m to ewer 1. .. -x (uma) S100'�(ddk)-f • Q .0O COM .._ ptimnit eoicriens Cyt,' '�d`"aeR�9�aeiri.nrle.p.s awing* ..a he. rumor .w.re.. ar a9•w.e..+e�:.d eev*-. O�edsde.nipherWgki' d• an &at e3 +�atra.rc+am„Lregn6KP,.. baflati( •rt'y.i.mim'Tktej-k inglionerdipereryrk mondrwaniramtlare aei.ea (pdR sou toNs Mar COV$ll7DItnIF CAM Tl9gDoeArrvtension OP MIMES AT 97-3/109 Is any of dr work so be performed a , , .. � - j... . r bcoapt 0 Yes .0 No ' • APPmmCANTsIGNATURB. r / . „,1" ff :.Garaisw DATE method ofp2yo of LT Cath 0 Check 0 Vi.R Baokard Number: • • - Authorized Siganzti t ' Spokeoe Corr Dividoo of&Odin ae Cade Edomernene • KU Were &oed..r4- n • Spofm%e WA 99160 Tel Na (509) 477.1675 a Pa No. jsW) 074791 * TDM (SPP) 4T741u L7 Maeteetard Expire.: Diswrer Cad sowirz • Nora Ave. 80.00' water +10'. 43' sewer house 56' 50'6" garage Os .elect. 19.5! Lexington Homes Mission Hills 1st Lot 2, Block 2 80.00' 25' Building Setback N O 0 APPROVED B _ Q ( " leo r"L' o "' A 9 SCALE: 1" = 20' Tuesday, Mar 18, 2003 11:52 AM k1 w 310 ;1 ro .t3 e O- O (528.640H 104.61' N HERALD -S U H RD. - 311 1 C rn D -4 Cf r O 1.► 0 89'