2003, 06-18 Permit App: BD03-646 Finish Basement City of b '90�g -V
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER /V/K,E SA6C-/SCA De-4y JOB LOCATION /7 17 S, 14x-icy/ ,O
OWNER'S ADDRESS' .)41it CITYsI. PHONE Ste'- Lys
/5'2./1-
DESCRIBE JOB 77.oisi<- 35,' z �
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED A?
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME i?LYZsc,v Grc.N 5"f"-- PHONE 9 -900
CONTRACTOR'S ADDRESS 7702 E. 77zeu( CITY 5c d.4v - `l S'z
CONTRACTOR'S REG.# 'PAR_sof d 612 EXPIRATION DATE 2/7/1
�{
CARD MUST BE PRESENTED AND COPIEDVERIFIED)
BOX 3 CONTACT PERSON OF PROJECT AVe c{ C ,/ PHONE CG- look'
ADDRESSC�c`' �Y'�• CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ r cosr-& c o EXISTING B VALUATION$
BOX 6 PROPERTY O RTY TAX ACCOUNT NUMBER ,
LEGAL DESCRIPTION JUN 18
2003
S(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE ALLDa uK ika I
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE(Existing/proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR /_ OTHER / BASEMENT FINISHED 1.3.35--/
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS,WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL.
BOX 10 Water Service meter size(if known) Also see BOX 4
BOX 11 Septic Tank-Not generally allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
BOX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFOR - - A •RK R WHICH THE APPLICATION IS MADE.
OWNER/AG DATE 61,/C__..1 (OVER)
4'
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard Expiration Date
Print the name of the Holder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
OFFICE USE ONLY- PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND. ADD/ALT
NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ -
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Received
yrai
pone 11707 E. SPRAGUE, STE 106
VIey SPOKANE VALLEY, WA 99266
(509)688-0036 FAX(509)688-0037 PROJECT TRANSMITTAL:
TRANSMITTAL DA 1'E:
SITE INFORMATION PERMIT INFORMATION
Site Address: I 1 - I S oG' ptd1/4Q Permit Number:O- -�4 Le Issue Date:
I
Permit Use: `Bets -Pv,,, 1-1 ✓l t
Parcel Number: Applicant:
Subdivision:
Block: Lot: Phone:
Zoning: Water Dist: Contact:
Owner:
Phone:
Address: Contractor: pa r S�, S
Building Inspector: K • Setbacks—Front: Left: Right: - Rear:
APPROVALS
BUILDINGS:
PLANN I 'G:
ENG 10 ERS:
HE: TH:
,WER:
FIRE DIS'1+ •
APPROVALS
WATER DIS :
STO ATER:
OTH ,R:
E-3,G �- ' `�- .7.7 Mg 2 .S
Zs
15
Scrit�xj�4/ � 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Sp ' ane Valley,WA 99206 509-688-0037-Fax
4000 Valley ?For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT qPERMIT
ADDRESS: (7f' ` 5' 12OG y/c 1 iat USE:
OWNER: p ig.F S4c4
bo^j � PHONE(Daytime Contact): ?L./-70a 7.
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: 1!�' LICENSE#:
MAILING ADDRESS: / PHONE#:
(street) (city/state) (Li') •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS / X $6 - a
2 URINALS X $6 -
3 TUBS X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6 - C
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 2 X $6 - /Z
RAY,FOOD,PREP/CULINARY/MEAT •
6 DISHWASHER I X $6 -
7 CLOTHES WASHER / X $6 - 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 t X $6 -
12 FOUNTAINS,DRINKING 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
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
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 =
SUBTOTAL: !7 g -_-
METHOD OF PAYMENTMOM
Vail • 4"ast PLUS PROCESSING FEE: $35.0
0 CASH 0 CHECK 0 MN= 0 L— .1:_`.
TOTAL PERMIT FEE DUE: ? _--
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
SOTY< 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
po'Tkane Spokane Valley,WA 99206' 509-688-0037-Fax '
.....0Valley
For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT —,--- PERMIT
ADDRESS: 0 i.(//11.• USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 4 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 X $15 -
2 FUEL BURNING APPLIANCE >100,000 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 1-100M 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 - 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 CONDMONER +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
ininli
i, pt' TOTAL PERMIT FEE DUE:
ElCASH ❑ CHECK 1:1 UMW El ..__ ._._ '.
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: