2004, 05-21 Permit App: BLD-04-04405 ResidenceSbnol an` e�
Malley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036Fax:f5091688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
/Oii Gl . r) gityccy
0350
ASSESSOR'S TAX PARCEL NtD4BEER(S):
LEGAL DISCRIPTI ON:
/p `? 2L.:o-1-17- 2
PERMIT DESCRIPTION:
I ]BUILDING PERMIT
u RELOCATION
CI C•HANGE IN USE - ❑ GRADING ❑ MANUFACTURZD HOME
fl SIGN 0 TENANT ❑ OTHER
OWNER / APPLICANT INFORMATION
❑ OWNER:
PHONE:
ADDRESe:
CONTRACTO
PHONE(
ADDRESS:
0 APPLICANT:
FAX: PHONE: FAX:
FAX:
141114‘.2
WA ST CONTRACTOR LICENSE"
TATE, ZIP
mit►�I�C�'. '
ACCZECS:
CITY, STATE, ZIP
ARCHITECT:
PHONE:
ADDRESS:
FAX:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHTTOPEAK;2J7
BUILDING DIMENSIONS:53 $ 45 '&
NUMBER OF STORIES:
NUMBER of BEDROOMS: 5
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
I\
30% SLOPES ON PROPERTY: ✓ V 0
OCCUPANCY GROUP: '
CONSTRUCTION TYPE: A -Z --a
STRUCTURES ON PROPERTY:--- 0 —
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:AkLeit
CURRENT SEPTIC USE: /VA
CURRENT WELL USE: A/A %
IMPERVIOUS SURFACE AREA: j 611 9 ;
2513
MAIN FLOOR SQ FT:_
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
5CC%
FINISHED BASEMENT /0/3
GARAGE: U‘
COVERED DECK:/�/
f
DECK: 0
MANUFACTURED HOME
SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE PLARM:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
TENT:
DATET[ IME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PHONE: FAX: -
PLANS EXAMINER:
ADDRESS:
INSPECTOR:
ADDRESS:
CITY, STATE, ZIP
PHONE: FAX:
I SPECIAL INSPECTIONS
o BOLTING
FIRM NAME:
INSPECTOR(S):
O CONCRETE
CITY, STATE, ZIP
® REINFORCEMENT ® WELDING
PHONE: FAX:
1
1
BUILDING STAFF USE ONLY
:IS PUBLIC SEWER AVAILABLE: El YES 0 NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: ❑ YES 0 NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PRQPERTY LOCATED WITHIN ASA: 00
YES NO PSSA: 0 YES 0 NO
1
DATE:
1
METHOD OF PAYMENT:
o a
CASH CHECK
BANKCARD
AUTHORIZED SIGNATOR
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
STAFF:
VIN #
'I.
azi e�``
��ley
PLUMBING PERMIT APPLICATION
PROJECT
/ //,2
OE''CRIFTION
I
6 ' iiitV L
PERMITADDRESS:
USE
X-
COST
OWNER
_ AMOUNT _.
1
PHONE (Daytime Contact):
MAIUNG
ADDRESS:
X
$8
2
URINALS
(street) (city/state)
(zip)
)
"P• "'
MAI�1
•CTOR: /
iStal u 4
ADDRESS:
I
l -al ± �vd
LICENSE 8:
�
y�
}�
rv?QQ y
! W I�ri'�
X
SHONE
I&!;
- 4.07q
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
(street) (city/state)
= '
(zip)
PLUMBING FIXTURES
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
FS:
1-
OE''CRIFTION
DETAILS -
# OF UNITS
X-
COST
EQI/4LS-..
_ AMOUNT _.
1
TOILETS
WATER CLOSET, BIDETS
X
$8
2
URINALS
-
X
$6
=
3
TUBS
1
_.
X
$6
-
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
11.
X
$6
_
6
DISHWASHER
'.
]
X
56
=
7
CLOTHES WASHER
—J
/
X
X
$6
56
=
=
8
GARBAGE DISPOSAL
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
56
=
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X-
$6
=
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, 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
*6
a
19
MEDICAL GAS per outlet
NfTROUS, OXYGEN
X
$6
=
20
MISC PLUMBING FIXTURE_
ii
X
$6
=
❑
-
-
lir
iggliia 0
WILL ONLY RE ACCEPTED
OF A MAJOR CREDIT
SUBTOTAL
.4
="
CASH ■ CHECK 0
PLUS PROCESSING
FEE
$35.00
FAXED PERMITS
WITH PAIMENT
CARD
TOTAL PERMIT FEE
DUE
DATE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
FS:
1-
,S l n� e
Walley
MECHANICAL PERMIT APPLICATION
PROJECT _ /u / / { _
ADDRESS: '/-}/i/
�iv
,....4-4..4--/"
r
PERMIT
USE:
USE:
OWNER:
COST
EQUALS
PHONE (Daytime Contact):
MAILING ADDRESS:
FUEL BURNING APPLIANCE
=OR<100,000
7X
(street)
city/state) ••
E
� f
1 /
2
W
7(zz�ip)
//��
fEp / 7 . - , /�CU 6t0
_.
MAILING AO6R SS:
- .. - _=1a_
... -ag...
PHONE t '
.4'84- - 1 qac
(city/state)
•99ao 7
40 I q f). 544
X
(street)
(zip)
BANKCARD NUMBER:
AUIiiORU2ED SIGNATURE:
DESCRIPTION -OF WORK
N or wars
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
=OR<100,000
7X
515
It
2
FUEL BURNING APPLIANCE - -- - ,"
>100,000- ...
_.
X
- .. - _=1a_
... -ag...
3
UNUSTED APPLIANCE (ADDITIONAL FEE)
=OR -c400,000
X
150
' as
4
UNLISTED APPLIANCE LADDMONAL FEE)
>400,000
X
1100
=
5
USED APPLANCE(WSEC min. AFUE rating)
=0R<400,000
X
150
=
6
USED APPLIANCE(WSEC ml n. AFUE rating)
>400,000
X
$100
=
7
BOILER/REFRIGERATION
1-100M BTU
X
115
_
8
BOILER/REFRIGERATION -
10/S00M BTU
X
$28
=
9
BOILER/REFRIGERATION
501-1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001-1,750M BTU
X
$57
=
11
BOILER/REFRIGERATION
+1750M BTU
X
$95
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
- -
/, .,
t
X
X
$10
110
=
=
13
RANGE
-
14
DRYER
-
/
X
110
. =
15
FUEL BURNING WATER HEATER
-
/
X
$10
=
16
MISCELLANEOUS FUEL BURNING APPL
-
X
$10
=
17
GAS PIPING (ea. Outlet)
-
=�
X
11
=
18
DUCT SYSTEMS
-
X
$10
=
19
VENTILATING FANS
-
-5
X
110
=
20
AIR HANDLER (DOES NOT Include ducting)
=OR<10,000CFM
X
112
.
21
PJR HANDLER (DOES NOT Include ducting)
>10,000CFM
X
119
=
22
EVAPORATIVE COOLERS
-
X
510
23
TYPE I HOOD-
X
150
C.
24
TYPE II HOOD
-
/
X
110
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
.112
=
26
AIR CONDITIONER
3-15 TON
X
120
-
27
AIR CONDITIONER
1530 TON
X
$25
=
28
AIR CONDITIONER
30-50 TON
X
$35
29
AIR CONDITIONER
.+50TON
X
160
=
30
LPG STORAGE TANK-
X
..>= 110
-:
...
31
WOOD OR PELLET STOVE/INSERT-
X
. 110
Is
32
WOOD STOVE -FREESTANDING-
-..
X-
O
D
-
'
I
SUBTOTAL
CASH • GHE • •
FAXED PERcSWILL ONLY/SE ACCEPTED
OF A MAJOR CREDIT
mATR. pxvV.a.
T•:,t
_a ` t
PLUS PROCESSING
FEE
- $35.00
WITHPAnmNT
CARD
TOTAL PERMIT FEE
DUE
BANKCARD NUMBER:
AUIiiORU2ED SIGNATURE:
Gas/Elec.
rsr
v
Nora Ave.
631-7.3"•To curve
It
17'-9"
f
Y 1
v
ro
9cu
tto
al
N1
vi
N i
O
31
1
Driveway
Split Entry
41
10x10
27'
ADDRESS
ZONE /r —
AD WIDTH �1 t�
COM ENTS FtANKINC
%IEif EDl.
pA 1M IM n /l
Deck
•
•
rtt
r
25'
•
m
Dartmouth Rd.
This sits pfd y p�B rramMfld for 0* purpose
reg pr ainl ng a OesarMa$onl ofhIproposal. AN permit and is a true and SOI
irentY
linea
�.indiestad tonna.0t.... 4 ▪ have/Wft16mIC3nft led Alsoeh
v :.. Of •'stet, steep e..,. or other Crated areas.
cit
• Signed*
✓ Dab:
Ico S..
En
v N
air Al
Scale:1 " = 20'
84'
Lexington Homes
10116 E. Nora Ave.
Lot 3 Block,2
.,E/ 1 A
*lane
4 jUalley
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
DEPARTMENT OF PUBLIC WORKS
Anticipated start date 5-25-2004 Permit # 04-343 Account #
ROW CONSTRUCTION PERMIT
Location of property 10116 E. Nora Ave.
(Address/Parcel #, if available)
Applicant Name Lexington Homes Inc. Fax
Address P.O. Box 141749 Spokane, Wa. 99214 Phone 509-924-1519
Contractor's Name Craig Caldwell Concrete
Address 4122 N. Pierce Rd. Spokane, Wa. 99206 Phone
Contractor's Reg.# CRAIGCC981NL Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
USewer Connection ® Driveway
Curb & Gutter ❑ Gas Installation/Repair
Cable/Conduit/Pole ❑ Sidewalk Repair/Construction
Water Installation/Repair D Other
Pavement Cut Dimensions
nd/insurance certification must be on file with the City. Bond #
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved
2
Date 5--2
/—O�-
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$ 25.00 25.00
Date
!nit
(Application) (Inspection)
In addition to the permit application fee of $16.00 (utility) or $25.00 (construction), inspection on
each permit will be billed to the permittee at a rate of $50.00 per hour with a $25.00 (1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily (Signed)
Date
Permit not valid until One -Call Notification Ticket # entered here
PERMIT MUST BE KEPT ON SITE