2003, 04-09 Permit App: BD03-065 Duplex to Residence City of
SPOKANE VALLEY
PERMIT # 03—�.
BUILDING PERMIT APPLICATION
Box 1 OWNER TDA►N .r:As-e,,,fir, jiseg JOB LOCATION
OWNER'S ADDRESS$? N ITY4.. ti! PHONE .22?-g5/
DESCRIBE JOB e_cnUro j,- ti J 7D S;L.45,16. -4 i/ /-es;cies G
y
THIS PROPERTY IS OWNED BY: SINGL MARRIED
PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME PHONE
CONTRACTOR'S ADDRESS CITY
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ 3(11)7' EXISTING BLDG.VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CD
CENSUS NUMBER LOT NUMBER -4 (j
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR / 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED /
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 PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT DATE (OVER)
r j
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 RECD 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
POST THIS CARD ON THE FRONT OF THE BUILDING
INSPECTIONS CITY OF SPOKANE VALLEY
509-921-1000 24 HOUR ADVANCE NOTICE IS REQUIRED
BUILDING AND FIRE DEPARTMENT INSPECTION� RECORD
PERMIT NUMBER O"� ADDRESS '57 7 5*9` ATE 4,tv37.3
SETBACKS: FRONT : REAR: SIDE A: SIDE B:
(Setbacks are the responsibility of the owner or agent and shall be per Community
Development approval)
CONCRETE WORK ccANt) 12.1- vkQ4.9 ) .1a r RC.DD
FOOTING REINFORCEMENT: CLEAN KEYED A 1 / �"
WALL REBAR OR REBAR STUB UPS SEISMIC TIE DOWNS
FOUNDATION WALL REINFORCEMENT: CLEAN
SET BACKS UNDER FLOOR VENTS FOOTING DRAINS
ROOF DRAINS DRAIN PIT DATE
DO NOT POUR CONCRETE UNTIL THE ABOVE ITEMS HAVE BEEN APPROVED
UNDER FLOOR FRAMING POST PINS OR BRACKETS
UNDERGROUND PLUMBING UNDER FLOOR PLUMBING
SLAB ON GRADE (3 1/2 " minimum) 4" GRAVEL / COMPACTED
R 10 INSULATION 6 mil PLASTIC UNDER SLAB DATE
DO NOT POUR CONCRETE UNTIL THE ABOVE ITEMS HAVE BEEN APPROVED
SEPARATE PERMITS MAY BE REQUIRED FOR PLUMBING AND MECHANICAL
ROUGH PLUMBING (WASTE AND VENT TO BE TOPPED OFF)
ROUGH HEATING GAS PIPING FRAMING SHEAR WALLS
WIND TIE DOWNS VENTILATION FANS AND VENTS DATE
SAFETY GLAZING 6 mil PLASTIC UNDER FLOOR
FIRE DEPARTMENT: ALARMS SPRINKLERS TEST INSP. DATE
THE ROUGH ELECTRICAL MUST BE SIGNED OFF BY LABOR&INDUSTRIES AND
ALL OF THE ABOVE APPROVED BY THE BUILDING INSPECTOR BEFORE
CONTINUING
INSULATION: FLOORS WALLS CEILING BAFFLES DATE
•
DO NOT APPLY WALLBOARD UNTIL ALL OF THE ABOVE IS APPROVED
WALLBOARD NAILING GARAGE SIDE AND OVERHEAD STORAGE
HEALTH DEPARTMENT ON SEPTIC SYSTEM
INSP. DATE
DO NOT APPLY TAPING UNTIL THE ABOVE IS APPROVED
FINAL APPROVALS: FIRE DEPARTMENT DATE
SEWER LINE (OR SEPTIC) DATE
WATER LINES DATE
STORM DRAINS DATE
ELECTRIC DATE
STREET CUT DATE
BUILDING DEPARTMENT DATE
DO NOT OCCUPY THIS BUILDING UNTIL THE CERTIFICATE OF
OCCUPANCY IS ISSUED BY THE BUILDING DEPARTMENT
S-v-INSP
• orrrr c +I' Flu 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
JOe Spokane Valley,WA 99206 509-688-0037-Fax
.000Valley
•Mechanical Permit Application J 3 " <Q5
PROJECT5� y �Y S A rG, PERMIT J�
ADDRESS: / USE: A 5 n p,
OWNER: D4Mrs-ELY PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE It:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #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) --
t- 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 CONDMONER 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
MIMIVISA' Vast' .
TOTAL PERMIT FEE DUE:
0 CASH ❑ CHECK ❑ Wiariai ❑ t.____7.±'':._
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: