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2004, 11-09 Permit App: 04009043 ResidenceProject Number: 04009043 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/09/2004 Page 1 of 4 Project Information: .:::::....................... Permit Use: NEW RESIDENCE W/ATTACHED GARAGE - NATURAL GAS Setbacks: Front 30 Left: 7 Right: 10 Rear: 61 Site Information: Plat Key: Name: SHELLEY LAKE 01ST ADD PUD Contact: MADDEN CONSTRUCTION Address: 10601 E NIXON AVE C - S - Z: SPOKANE VALLEY, WA 99206 Phone: (509) 924-6497 Group Name: Project Name: District: Parcel Number: 45241.1802 Block: 1 SiteAddress: 358 S SHELLEY LAKE LN Location:: CSV Zoning: UR -3.5 Urban Residential 3.5 Water District: Area: 10,502 Sq Ft Width: 0 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Lot: 2 Owner: Name: MADDEN CONSTRUCTION Address: 10601 E NIXON AVE SPOKANE VALLEY, WA 99206 Hold: ❑ Depth: 0 Right Of Way (ft): 30 Review Site Plan Review Plan Review Released By: Approach / Drainage Released By: Sewer Review Permits: Operator: K_C Printed By: K_C Print Date: 11/09/2004 Project Number: 04009043 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/09/2004 Page 2 of 4 Contractor: KEVIN MADDEN Address: E. 10601 NIXON LN SPOKANE, WA 99206 Item Description APPROACH INSPECTION CONST IN ROW - APPROACH Contractor: KEVIN MADDEN Address: E. 10601 NIXON LN SPOKANE, WA 99206 Group: R-3 Building Height Stories Dwelling Units Description 2ND FLOOR BASEMENT U GARAGE RESIDENCE Type: VB 33 2 1 R-3 R-3 U-1 R-3 Approach Firm: KEVIN MADDEN CONSTRUCTIO Phone: (509) 924-6497 Units Unit Desc 1 NUMBER OF 1 NUMBER OF Fee Amount $25.00 $25.00 Permit Total Fees: $50.00 Building Permit Firm: KEVIN MADDEN CONSTRUCTIO Phone: (509) 924-6497 Building Characteristics Ing Notes VB VB VB VB Item Description RESIDENTIAL PERMIT FEE STATE SURCHARGE RESIDENTIAL PLAN REVIEW This Application: Sq Ft Valuation 970 $72,439.60 532 $7,980.00 1,132 $21,508.00 780 $58,250.40 Totals: 3,414 $160,178.00 Units Unit Desc 1 SELECT 1 SELECT 1 SELECT Operator: K_C Printed By: K_C Permit Total Fees: Total Project: Sq Ft Valuation 970 $72,439.60 532 $7,980.00 1,132 $21,508.00 780 $58,250.40 3,414 $160,178.00 Fee Amount $1,335.35 $4.50 $534.14 Print Date: $1,873.99 11/09/2004 Project Number: 04009043 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 11/09/2004 Page 3 of 4 Contractor: KEVIN MADDEN Address: E. 10601 NIXON LN SPOKANE, WA 99206 Item Description GAS WATER HEATER GAS APPLIANCE<=100,000BTU GAS PIPING VENTILATING FANS CLOTHES DRYER GAS LOG OR GAS INSERT HOOD -TYPE II Contractor: KEVIN MADDEN Address: E. 10601 NIXON LN SPOKANE, WA 99206 Item Description TOILETS/BIDETS SINKS SHOWERS TUBS DISH WASHERS GARBAGE DISPOSAL CLOTHES WASHER FLOOR DRAINS WATER USING DEVICES Mechanical Permit Firm: KEVIN MADDEN CONSTRUCTIO Phone: (509) 924-6497 Units Unit Desc 1 NUMBER OF 1 NUMBER OF 3 # OF UNTTS 3 NUMBER OF 1 NUMBER OF 1 NUMBER OF 1 NUMBER OF Permit Total Fees: Plumbing Permit Units 3 5 1 2 1 1 1 1 2 Operator: K_C Printed By: K_C Fee Amount $10.00 $12.00 $3.00 $30.00 $10.00 $10.00 $10.00 $85.00 Firm: KEVIN MADDEN CONSTRUCTIO Phone: (509) 924-6497 Unit Desc NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF Permit Total Fees: Print Date: Fee Amount $18.00 $30.00 $6.00 $12.00 $6.00 $6.00 $6.00 $6.00 $12.00 $102.00 11/09/2004 Project Number: 04009043 Inv: 1 Application Date: 11/09/2004 Page 4 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: ; DO NOT ISSUE SEWER PERMIT - OK TO ISSUE HOUSE PER ROGER 10/27/98 OK TO ISSUE SEWER PERMITS FOR: BLK 4- L 1 BLK 5- L 2,16,18 BLK 6 - L 1,3,5,6,9,10 BLK 7 - L 1,2 Payment Summon,: Permit Type Fee Amount Invoice Amount Approach $50.00 $50.00 Building Permit Mechanical Permit Plumbing Permit $1,873.99 $85.00 $102.00 $1,873.99 $85.00 $102.00 Amount Paid $0.00 $0.00 $0.00 $0.00 Amount Owing $50.00 $1,873.99 $85.00 $102.00 $2,110.99 $2,110.99 $0.00 $2,110.99 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: K_C Printed By: K_C Print Date: 11/09/2004 Stiokane 40,Valley Ckfi3 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: 35-5.- ASSESSOR'S 5 ASSESSOR'S TAX PARCEL NUMBER(S): La LEGAL DISCRIPTION: /)-( /o'ikkt PERMIT DESCRIPTION: 'i BUILDING PERMIT . IJ CHANGE IN USE .0 GRADING . Q MANUFACTURED HOME -Ok1IER... 0 -RELOCATION Q SIGN Q -TENANT OWNER /APPLICANT INFORMATION 0 OWNER: WZ^ 1L''LicifiCko--":1 13 APPLICANT: /5--- V,/;1//),) PHONE:929-6,41972(7- , 7 FZe PHONE: 7-17; 7e 2 FAX: ADDRESS:.(- //Or; 0,,r /// ."0^i bk Vtg, Wia--'.N.7C4ADDRESS: /, (4 t t,;',-",).. mow.; ? _1 p / 0-5 1 CITY, TATE, ZIP '' . CITY, STATE, ZIP CI ARCHITECT: � . v: f)1 -du i ®CONTRACTOR: eo o /' )ate! e'/ PHONE:/%tomo FAX: PHONE:: X:T/?? ei FAX: ADDRESS./.2 I FD�VP53 ffpo. VI': u / ? 04 ,I CITY, STATE, ZIP WA ST CONTRACTOR LICENSE4 V/d �`'lC /7'(0r 5- ©T/.?5/O CONTACT: )cV/ /►i ADDRESS: o CITY, STATE, ZIP 1c a/T' PERMIT/BUILDING INFORMATION COST OF PROJECT: 30% SLOPES ON PROPERTY: /17/9.. BUILDING HEIGHT TO PEAK: 3 OCCUPANCY GROUP: MAIN FLOOR SQ 2ND FLOOR S r1 C BUILDING DIMENSIONS: 4// X .-"a >g, CONSTRUCTION TYPE: ,' a— ^% e- UNFINASiMENTi "/ '5' NUMBER OF STORIES: gP/i e"' STRUCTURES ON PROPERTY: / FINISHED BASEMENT:/( NUMBER of BEDROOMS: 3 CRITICAL AREAS: , O,e-- GARAGE: 11 al FLANKING SETBACK: CURRENT PROPERTY SIZE: /6'..1– 0COVERED DECK: FRONT SETBACK: 3.0 CURRENT PROPERTY USE: Va-ca-N't /Jot DECK: REAR SETBACK: C / CURRENT SEPTIC USE: 44. LEFT SETBACK: 7 CURRENT WELL USE: /Y' RIGHT SETBACK: / 0 IMPERVIOUS SURFACE AREA: /)i.)018 - WA STATE NON-RESIDENTIAL ENERGY CODE 1 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: FIRE ALARM: PAINT BOOTH: TENT: FIREWORKS DISPLAY: BLASTING: DATE/TIME: PLANS EXAMINER: PHONE: FAX: ADDRESS: CITY, STATE, ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY, STATE, ZIP SPECIAL INSPECTIONS ❑ BOLTING FIRM NAME: INSPECTOR(S): OCONCRETE REINFORCEMENT PHONE: WELDING FAX: 1 BUILDING STAFF USE ONLY 1 IS PUBLIC SEWER AVAILABLE: 0 YES CI NO IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY CITY 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 0 NO PSSA: 0 YES 0 NO DATE: METHOD OF PAYMENT: 1 STAFF: CASH CHECK BANKCARD #• EXP/RES: VIN # AUTHORIZED SIGNATURE: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD PLUMBING PERMIT APPL'ICATI'ON n - Phone: (509) 688-0036; FAX: (509) 688-0037 a"ValleY For Inspections, CaII (509) 688-0054 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Project Address: Permit Use: Phone (Daytime Contact): Owner: Mailing Address: City State Zip Code Contractor: License #: Phone #: Mailing Address: City State Zip Code BANKCARD NUMBER: AUTHORIZED SIGNATURE: OF WORK # OF UNITS X COST = TOTAL AMOUNT DESCRIPTION WATER CLOSET, BIDETS o(„q X $6.00 = 1 TOILETS MA. X $6.00 = 2 URINALS / X $6.00 = 3 TUBS TRAP) BATH, STALL, ON-SITE BUILT / X $6.00 = 4 5 SHOWERS (PER SINKS LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT 1 X $6.00 = DISHWASHER / X $6.00 = 6 CLOTHES WASHER / X $6.00 = 7 8 GARBAGE DISPOSAL / X $6.00 WATER SOFTENER tt1t A X $6.00 = 9 ELECTRIC HOT WATER TANK NOTE: IF GAS, SEE MECHANICAL / X $6.00 = 10 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE / X $6.00 = 11 ROOF DRAINS/OVERFLOW DRAINS N A X $6.00 = 12 FOUNTAINS, DRINKING // A X $6.00 = 13 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTEATI N, REPAIR, iY x���/-I C� . ,1 t� 7 X $6.00 = 14 15 SEWAGE EJECTOR GRINDER, SUMP PUMP // ^^ X $6.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER /)O d &i X $6.00 = 17 CROSS CONNECTION DEVICE VACUUM BREAKER, CHECK VALVE, AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS // /1/4 X $6.00 = 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK yy// /Yfr X $6.00 = 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN /y4 X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE /Y0h/e- X $6.00 = 21 PRIVATE SEWAGE DISPOSAUSYS NX X $20.00 = 22 INDUSTRIAL WASTE INTERCEPTOR ��// /III X $15.00 = METHOD OF PAYMENT: 0 CASH 0 CHECK 0 VISA 0 MASTERCARD ^- FYPIPFR. SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: Project Address: Owner: Mailing Address: MECHANICAL PERMIT APPLICATION Phone: (509) 688-0036; FAX: (509) 688-0037 For Inspections, Call (509) 688-0054 Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Permit Use: Phone (Daytime Contact): City Contractor: License #: Mailing Address: State Phone #: Zip Code State Code AUTHORIZED SIGNATURE: DESCRIPTION OF WORK # OF UNITS X COST = TOTAL AMOUNT 1 FUEL BURNING APPLIANCE Equal to or Tess than 100,000 X $12.00 = 2 FUEL BURNING APPLIANCE More than 100,000 X $15.00 = 3 UNLISTED APPLIANCE (Additional Fee) Equal to or less than 400,000 X $50.00 = 4 UNLISTED APPLIANCE (Additional Fee) More than 400,000 X $100.00 = 5 USED APPLIANCE (WSEC min. AFUE rating) Equal to or less than 400,000 X $50.00 = 6 USED APPLIANCE (WSEC min. AFUE rating) More than 400,000 X $100.00 = 7 BOILER/REFRIGERATION 1 - 100M BTU X $12.00 = 8 BOILER/REFRIGERATION 101 - 500M BTU X $20.00 = 9 BOILER/REFRIGERATION 501 - 1,000M BTU X $25.00 = 10 BOILER/REFRIGERATION 1,001 - 1,750M BTU X $35.00 = 11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 = 12 GAS LOG, GAS INSERT, GAS FIREPLACE / X $10.00 = 13 RANGE X $10.00 = 14 DRYER X $10.00 = 15 FUEL BURNING WATER HEATER / X $10.00 = 16 MISC. FUEL BURNING APPLIANCE X $10.00 = 17 GAS PIPING (each outlet) / X $1.00 = 18 DUCT SYSTEMS / X $10.00 = 19 VENTILATING FANS X $10.00 = 20 AIR HANDLER (DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 = 21 AIR HANDLER (DOES NOT include ducting) Greater than 10,000 CFM X $15.00 = 22 EVAPORATIVE COOLERS X $10.00 = 23 TYPE I HOOD X $50.00 = 24 TYPE II HOOD X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 = 26 AIR CONDITIONER 3-15 TON X $20.00 = 27 AIR CONDITIONER 15-30 TON X $25.00 = 28 AIR CONDITIONER 30-50 TON X $35.00 = 29 AIR CONDITIONER More than 50 TON X $60.00 = 30 LPG STORAGE TANK X $10.00 = 31 WOOD OR PELLET STOVE/INSERT X $10.00 = 32 WOOD STOVE - FREE STANDING X $25.00 = 33 REPAIR & ADDmONs X $15.00 = 34 VENTILATION SYSTEMS X $12.00 = 35 VENTILATION MECHANICAL EXHAUST X $12.00 = 36 INCINERATOR - RESIDENCE X $19.00 = 37 INCINERATOR - COMMERCIAL X $22.00 = METHOD OF PAYMENT: 0 CASH 0 CHECK 0 VISA 0 MC CARD #: DATE: SUBTOTAL PROCESSING FEE $35.00 EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: CESS zoNE now viwThi FROM• cotAmw aEvlemE° \4 V s site plan Is being ot,t,-rinrng a building permit and n cation of the proposal Ur • iensu ns, curb lines, St ha.,' ween identified. Also bu, tr,•s of w. : r, steep slopes Signe Date: tor ttie purpose of a true and correct M MOM property and sss•n1 P t S etre Wet la OMler atltical a r / 77t J-- 5'01' 35-8 5. 5 ti -ELL CY LK. LN. LOT Z B,Loc,g• -1- 18 33 �� 1 t n5 t -IJ V&LOPt= 1q5-Dz LoT