2003, 11-19 Permit App: BLD-03-03102 RemodelPERMIT 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:
SS/ cam /1. 72,eEs� c
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
UILDING.PERMIT
E LOCATION
A—? -1
IPI CHANGE IN USE
®-SIGN
• U.GRADING .MANUFACTURED HOME
Q TENANT D OTRER... •
OWNER / APPLICANT INFORMATION
Mr:OWNER: `'r uz ?1° d'/eie'I' -' APPLICANT: QYio( �w/
PHONE: if Za - 6793 FAX: / PHONE: �L7' /.° FAX:
ADDRESS: SSO V. 7' G% ` Ya ADDRESS: 7 ? G - e F-
CITY,STATE, ZIP . CITY, STATE, ZIP
CONTRACTOR: ��' 5�:/VS GfG"tr
PHONE: 9z' - 9G10 S FAX:
ADDRESS:
7703 14- 47 7Z
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE #
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: date,
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON. PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
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: FIRE ALARM:
PAINT BOOTH: TENT:
FIREWORKS DISPLAY:
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
0 BOLTING °CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
0 WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO IF YES: 0 COUNTY 0 CITY
CI
IS PUBLIC WATER AVAILABLE: 0 YES NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES 0 NO PSSA: 0 YES 0 NO
DATE:
METHOD OFPAYMENT.:
0 0
CASH CHECK
STAFF:
1
1
WSA
BANKCARD#; EXP/RES: V/N#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
ETHOD 0
1 CASH
*Rime01
.0,0Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
509-688-0037 - Fax
Spokane Valley, WA 99206
PROJECT
ADDRESS: C's'JO
p/. 7
--- G (
PERMIT
USE:
OWNER: G.,,
Ey(.
EQUALS
PHONE (Daytime Contact):
MAILING ADDRESS:
TOILETS
WATER CLOSET, BIDETS
J
(street)
$6
(city/state)
(ZIP)
CONTRACTOR:
irTV
d rP a! eo c.
LICENSE #:
X
MAILING ADDRESS:
-
PHONE #:
/10 -YID
(street)
$6
(city/state)
(LIP) •
PLUMBING FIXTURES
ATE: EXPIRES:
kNKCARD NUMBER:
UTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
J
X
$6
-
G
2
URINALS
X
$6
-
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
(
X
$6
_
G
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
I
!
X
' $6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6
-
8
GARBAGE DISPOSAL
X
$6
-
9
WATER SOFTENER
X
$6
-
10
ELECT. 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
$6
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6
-•
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D. FOR: VATS, TANKS, BOILERS
X
-
17
SPRINKLER SYSTEM
X
825
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
7 PAYMENT _
. '411faSte,;
SUBTOTAL:
3
PLUS PROCESSING FEE:
$35.00
■ CHECK 0 Man ■
._ _:.:_.. _
TOTAL PERMIT FEE DUE:
7/ •----
ATE: EXPIRES:
kNKCARD NUMBER:
UTHORIZED SIGNATURE:
EXHAUST FANS
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