2003, 10-16 Permit App: BLD-03-02794 Residence Siö1e"
.00Valley
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: c9 44_`-'- `'7 bin
ASSESSOR'S TAX PARCEL NUMBER(S): '/5:. 1 (9
LEGAL DISCRIPTION: h o1- % /3/OG/ R� k-f 4-1—
itier
PERMIT DESCRIPTION:
O B LDING PERMIT CI-CHANGE IN USE a GRADING 0 MANUFACTURED HOME
(RELOCATIONQ SIGN ]TENANT Q]-O111ER
OWNER / APPLICANT INFORMATION
OWNER: ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP - CITY,STATE,ZIP
CONTRACTOR: �u57- &$e Lha ARCHITECT:
PHONE: 927- 3(0 5 7 ¢/X
FAX: 72'z-- 7go e PHONE: FAX:
ADDRESS:o2i2 S. CA k
CI
‘PW-64 ADDRESS:
CIfY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION f
COST OF PROJECT: 30%SLOPES ON PROPERTY: Ab MAIN FLOOR SQ FT: 7774/
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS:5s x Ge CONSTRUCTION TYPE: UNFIN BASEMENT: /fciel
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: Arc FINISHED BASEMENT:
NUMBER of BEDROOMS: 1- CRITICAL AREAS: GARAGE: goo
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: 3:5-- CURRENT PROPERTY USE: DECK: 2'O
REAR SETBACK: lZ 3 CURRENT SEPTIC USE:
LEFT SETBACK: // CURRENT WELL USE:
RIGHT SETBACK: SS.- IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN I
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:y
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
\ ..
WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
I
a BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
1
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY a CITY
IS PUBLIC WATER AVAILABLE: a YES a 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: ® YES ® NO PSSA: ® YES ® NO
IDATE: ' STAFF:
METHOD OF PAYMENT:
a a ® r Ta .�._
' ► VISA
CASH CHECK numumE
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
a
carr 0I 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
PO ane Spokane Valley,WA 99206 509-688-0037-Fax
.I0Valley
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: 1/0 /� LICENSE#:
MAILING ADDRESS: -' ( PHONE II:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 lm X ' $15 =
2 FUEL BURNING APPLIANCE >100,000 f X $19 -
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 =
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X , $50
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION I-100M BTU X $15 -
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 . $57
11 BOILER/REFRIGERATION +1750M BTU X $95 -
12 GAS LOG,GAS INSERT,GAS FIREPLACE - / X $10 =
13 RANGE - / X $10 =
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - / - X $10 -
16 MISC.FUEL BURNING APPL. - X - $10 -
17 GAS PIPING(ea.Outlet) - / X $1 -
18 DUCT SYSTEMS - / X $10 -
19 VENTILATING FANS - !O X $10 -
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM 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 +50 TON X $60 -
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X • $10
32 WOOD STOVE-FREE STANDING - X $25 -
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
1M0111 ,
;yip TOTAL PERMIT FEE DUE:
VISA' •❑ CASH ❑ CHECK ❑ 111M1111 ❑ •' �_"
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
art<x , 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
Spore 4
Spokane Valley,WA 99206 509-688-0037-Fax
4000 Valley
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (LIY)
CONTRACTOR:4ir / ��1,0v LICENSE 1:
7 MAILING ADDRESS: / PHONE Ii:
(street) (city/state) (LIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 -
2 URINALS X $6 -
3 TUBS a X -
$6
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD;PREP/CULINARY/MEAT
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
0 X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS X $6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP / X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6 -
SWAMP COOLER •7
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND >
R.P.B.P.D.FOR:VATS,TANKS,BOILERS 0 X $6 -
17 SPRINKLER SYSTEM ( X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK 6 X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN 0 X $6 -
20 MISC.PLUMBING FIXTURE a X $6 -
SUBTOTAL:
ETHOD OF PAYMENT
UMW
• olf st : PLUS PROCESSING FEE: $35.00
CASH ❑ CHECK ❑ NUM ❑ %.._. .....f.:-.....-.. -
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
kNKCAR.D NUMBER:
JTHORIZED SIGNATURE:
LICENSE DETAIL INFORMATION Form . Page 1 of 2
t
STATE OF WASHINGTON
DEPARTMENT OF LABOR AND INDUSTRIES
Specialty Compliance Services Division
P. O. Box 44000 Olympia,WA 98504-4000
THE RESULT OF YOUR INQUIRY FOR LICENSE NUMBER SELECTED IS:
LICENSE DETAIL INFORMATION
Current Filter: None
Registration#or License EASTMCI971 CK
Name EASTMAN CONSTRUCTION INC
Address 6222 S CHESTER CREEK LANE
Address
City SPOKANE
State WA
Zip 99206
Phone Number
Effective Date 9/3/2003
Expiration Date 9/3/2005
Registration Status ACTIVE
Type CONSTRUCTION CONTRACTOR
Entity CORPORATION
Specialty Code GENERAL
Other Specialties UNUSED
UBI Number 602260903
*
'VIEW CROSS REFERENCE FILE FOR THIS LICENSE* * *
*
'VIEW PRINCIPAL OWNER(S) FOR THIS LICENSE* * *
'VIEW*VIEW CONTRACTOR BOND/SAVINGS INFORMATION * *_*
'CHECK*CHECK INQUIRY FOR SUMMONS AND COMPLAINTS* * *
* * * VIEW CONTRACTOR INSURANCE INFORMATION *_*_*
New inquiry by CITY , NAME , PRINCIPAL OWNER NAME_ , LICENSE , UBI
NUMBER, check the
L&I Contractor Industrial Insurance Premium Status or return to the L,&I Construction
Compliance Home Page
https://wws2.wa.gov/Ini/bbip/TF2Form.asp?License=EASTMCI971CK 10/16/2003
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APPROVED BY v 4-,f6„(