2003, 10-02 Permit App: BLD-03-02654 Remodelsoatrne.,
1ValleY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: /070 20,, (20Z"et £P . 49h -
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: %j%,e,(,')
UILDING PERMIT 0 CHANGE IN USE
[RELOCATION 0 SIGN
/r/
D GRADING 0 MANUFACTURED HOME
DTENANT 'DOTTIER
OWNER / APPLICANT INFORMATION
® OWNER:
PHONE:
ADDRESS:
S�
- CITY
✓- 7 : 1
CONTRACTOR.A � ,C
PHONE: `74(7.-72(n w FAX:
ADDRESS:
® APPLICANT:
PHONE: FAX:
.r..Z ADDRESS:
WA ST CONTRACTOR LICENSE #
ITY, STATE, ZIP
99,0_3
5
-7.0/
0
r
CITY, STATE, ZIP
ARCHITECT:
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: '/' it j LI
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
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:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE _ I
1
PLANS EXAMINER:
ADDRESS:
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
0 BOLTING
FIRM NAME:
®CONCRETE
® REINFORCEMENT ® WELDING
PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: 0 YES ® NO
IS PUBLIC WATER AVAILABLE: 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 ® NO PSSA: ® YES ® NO
IF YES: ® COUNTY ® CITY
I DATE:
METHOD OF PAYMENT::
0
CASH CHECK
BANKCARD #; EXP/RES,; VIN #
AUTHOR/ZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
(]TY OE
Spokane
.0.0Valley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT ��
ADDRESS: f t� /V cel s l Ih � 4 ,
PERMIT
USE:
DETAILS
# OF UNITS
X
OWNER:/JI� /y ,,/� /'/
PHONE (Daytime Contact):
- .-
�J
1
;7 5�
MAILING AD RESS.
` ailly
' i - I -IA- -ivi 7( A
/6/io J- Lk} 6e- - /
f s.
,9)
$6
(street) (city/state) (ZIP)
2
URINALS
CONTRACTOR.'
LICENSE #:
X
$6
-
MAILING ADDRESS: /
i-4,PL / a f9) S
PHONE #: //// ey_in
..'
X
$6
-
(street) (city/state) (L11') '
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
PLUMBING FIXTURES
"HOD 0
;ASH
E:
KCARD NUMBER
HORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
-
2
URINALS
X
$6
-
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
X
$6,
-
7
CLOTHES WASHERpi-
�
0
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
R.P.B.P.D. FOR: VMS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
'
CHECK ❑ 11111101111
Rowse r ,+
SUBTOTAL:
PLUS PROCESSING FEE
-
$35.00
TOTAL PERMIT FEE DUE:
E:
KCARD NUMBER
HORIZED SIGNATURE:
sridiarie
,.Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
METHOD OF PA
❑ CASH 0
DESCRIPTION OF WORK
PROJECT
ADDRESS:
8 OF UNITS
PERMIT
USE:
OWNER:
EQUALS
PHONE (Daytime Contact):
MAILING ADDRESS:
FUEL BURNING APPLIANCE
(street)
(city/state) (ZIP)
CONTRACTOR:
' $15
LICENSE #:
MAILING ADDRESS: • •
2
PHONE #:
> 100,000
(street)
(city/state) (ZIP)
519
=
METHOD OF PA
❑ CASH 0
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
8 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR < 100,000
X
' $15
=
2
FUEL BURNING APPLIANCE
> 100,000
X
519
=
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
= OR <400,000
X
550
=
4
UNLISTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
5100
=
5
USED APPLIANCE (WSEC min. AFUE rating)
= or < 400,000
X
s 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
528
.
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39
=
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
$57
-
11
BOILER/REFRIGERATION
+1750M BTU
X
595
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
510
=
13
RANGE
-
X
510
14
DRYER
-
X
510
=
07
15
FUEL BURNING WATER HEATER
-
-
X
$10
16
MISC FUEL BURNING APPL.
-
X
510
=
17
GAS PIPING (ea. Outlet)
-
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)
> 10,000 CFM
X
519
=
22
EVAPORATIVE COOLERS
-
X
$10
-
23
TYPE I HOOD
-
X
$50
24
TYPE II HOOD
-
X
510
-
25
HEAT PUMP/AIR CONDMONER
0-3 TON
X
512
-
26
AIR CONDMONER
3-15 TON
X
$20
-
27
AIRCONDMONER
15-30 TON
X
525
=
28
AIR CONDITIONER
30-50 TON
X
$35
=
29
AIR CONDITIONER
+50 TON
X
560
=
30
LPG STORAGE TANK
-
X
510
=
31
WOOD OR PELLET STOVE/INSERT
-
X
510
=
32
WOOD STOVE - FREE STANDING
-
X
525
KENT
VISA' •i rwSY,_ ." ".
^------.
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
—
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: