2004, 06-21 Permit App: BLD-04-04674 ResidenceSpCITY (Ir
okane
.00. Valley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
Application #:
Job Address: 804 S SHELLEY LAKE LN
VERADALE WA
Description: NEW RESIDENCE W/ATTACHED GARAGE - NATURAL GAS
Subdivision:
Owner:
Applicant:
Address:
Contractor:
Address:
MADDEN, KEVIN M
MADDEN CONSTRUCTION
10601 E NIXON LN
SPOKANE VALLEY, WA 99206
KEVIN MADDEN CONSTRUCTION
10601 E NIXON LN
SPOKANE WA 99206-3794
Lot:
Blk: Parcel No:
Phone: (509) 924-6497
Phone:
Lic No:
(509) 927-7526
KEVINMC146J5
Applied:
Issued:
Expires:
BLD -04-04674
06/21/2004
12/18/2004
Zoning:
General Information:
TYPE OF RESIDENTIAL PERMIT
VALUATION
BUILDING HEIGHT TO PEAK
DIMENSIONS
# OF STORIES
# OF BEDROOMS
FRONT SETBACK
REAR SETBACK
LEFT SETBACK
RIGHT SETBACK
OCCUPANCY GROUP
CONSTRUCTION TYPE
STRUCTURES ON PROPERTY
CURRENT PROPERTY SIZE
SERVED BY SEPTIC SYSTEM
WELLS LOCATED ON PROPERTY
TOILETS
TUBS
SHOWERS (PER TRAP)
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
WATER PIPING/DRAIN-IN WASTE
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
RANGE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING (ea. OUTLET)
VENTILATING FANS
TYPE II HOOD
sfr
238564
32
41 x 58
2
3
30
65
6
6
r-3
5-n
1
70 x 137
no
no
2
2
1
5
1
1
1
1
1
3
1
2
0
1
1
4
3
1
Fees:
PLAN CHECK FEE
TYPE II HOOD
BASIC PERMIT FEE
WSBCC SURCHARGE
TOILETS
TUBS
SHOWERS
SINKS
DISHWASHER
CLOTHES WASHER
GARBAGE DISPOSAL
FLOOR DRAINS
WATER PIPING/DRAIN-IN WASTE
WATER USING DEVICE
FUEL BURNING APPL <= 100,000
GAS LOG, INSERT, FIREPLACE
DRYER
FUEL BURNING WATER HEATER
GAS PIPING
VENTILATING FANS
siaanc
icy
REVIEWED FOR CODE COM
SPOKANE VALLA BUILDING
Total Calculated:
Deposits/Receipts:
Total Due:
708.86
10.00
1,772.15
4.50
12.00
12.00
6.00
30.00
6.00
6.00
6.00
6.00
6.00
18.00
15.00
20.00
10.00
10.00
4.00
30.00
2,692.51
0.00
CITY OF SPOKANE VALLEY
APPROVED FOR SUBMITTAL
LISInitials / Date
'VISION
ION
2,692.51
b 1 ads/ oc--/
A
L
RECEIPT
.o (�
Spokane
,,,,,°Milley
11707 E. Sprague Ave., Suite 106
Spokane Valley, WA 99206
THIS IS NOT A PERMIT
Penalties will be assessed for
commencing work without a permit
NEW SINGLE FAMILY RESIDENTIAL
THIS IS NOT A RECEIPT
Application #: BLD -04-04674
Spouliane
doonalley
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address:
Sc 5 SA�r�
Assessor's Tax Parcel Number(s):
Legal Description: 101" 5 /3 kx, k 1 Shed
PERMIT DESCRIPTION: tel,l t5‘ aencc
Building Permit
❑ Relocation
K cc Jccc d! 4cE
❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Tenant Improvement 0 Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: GUI/i 11'6014-4 as{
Phone: 9--'-/-4,W7 Fax:
Address: Via/ / E MA -an .Ch.
PDG �&G
iTY State Zip Code
Contractor:
Phone:
Address:
52MC
Fax:
City
Applicant:
Phone: Fax:
Address:
City State Zip Code
El Architect:
Phone: Fax:
Address:
State Zip Code City
WA State Contractor License #: MC 14/G13 -Contact:
State Zip Code
4-h
PERMIT/BUILDING INFORMATION •
HEIGHT TO PEAK: 3-) 1ave,
DIMENSIONS:
/___j_Y,Te
# OF STORIES:
MAIN FLOOR TOSc �. FTG:
77VFINISHED
2"" FLOOR SQ. TG:
UNFIN BASEME T SQ. FTG:
BASEMENT SQ. FTG:
GARAGE SQ. FTG:
If
DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
LarYi Firdile
HEAT SOURCE:
IMPERVIOUS
IMPERVI� SURFACE AREA:
-�
# OF BEDROOMS:3
TOTAL HABITABLE SPACE:
)34‘3
COST OF PROJECT:
...)‹...V., eine')
30% SLOPES ON PROPERTY:
$
SEWER OR ON-SITE SEPTIC
SYSTEM? 4,Cr-
MANUFACTURED HOME
Width:
Length: Year:
Manufacturer:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Phone:
Fax:
City
Inspector: Phone:
Address:
State
Fax:
Zip
City
State
Zip
SPECIAL INSPECTIONS
0 BOLTING 0 CONCRETE
Firm Name:
0 REINFORCEMENT
Phone:
I nspector(s):
Fax:
0 WELDING
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane VaIley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a. permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name KeorA f SIJl4 Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
0 Cash ❑ Check 0 Mastercard
Bankcard #:
Authorized Signature:
0 .VISA
Expires:
VIN#:
0 Other
Silo"lane
MECHANICAL PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Vattey, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Permit Use:
9adU-h 45'7
Zip Code
Zip Code
Project Address: 704i. 5 • 5/1 cf/L7 L.k. 1a -1.c
Owner: "KLu►-N WtiaSd cn
Mailing Address: /0Go/ E AI/ Xaa /..,e -,-c.
Contractor. K ^ License #:
Mai ing Address: /D6a/ F 4/ors L
Phone (Daytime Contact):
cZ 2flj iw (/4///•
City
State
/6-1/1 /1C , // S"-- Phone #:
5poletwic
cityy State
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
I
X
$15.00
=
IS, 60
2
FUEL BURNING APPLIANCE
More than 100,000
X
$19.00
=
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
$15.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
$28.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
$39.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
$57.00
=
11
BOtLERIREFRtGERATION
More than 1 750M BTU
X
$95.00
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
arD
X
$10.00
=
.)O , o:7
13
RANGE ` i+1- ,
1
X
$1000
=
/0 . Cr,
14
DRYER
X
$10.00
=
15
FUEL BURNING WATER HEATER
1
X
$10.00
=
10 , OZ7
16
MISC. FUEL BURNING APPLIANCE
X
$10.00
=
17
GAS PIPING (each outlet)
3
1
X
X
$1.00
$10.00
=
=
3 , OO
ID . CO
18
DUCT SYSTEMS
19
VENTILATING FANS
3
x
$10.00
=
3() , C70
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
$19.00
=
22
EVAPORATIVE COOLERS
X
$10.00
=
23
TYPE 1 HOOD
X
$50.00
=
24
TYPE II HOOD
1
X
$10.00
=
j O. CX_7
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12.00
=
26
AIR CONDITIONER
3-15 TON
X
$2000
=
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
=
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
CARD #:
DATE:
SUBTOTAL
PROCESSING FEE
EXPIRES:
TOTAL PERMIT FEE DUE:
'!$35.00
I `/ .
AUTHORIZED SIGNATURE:
I
*lane
4,1/alley
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuiidingDivision
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
FOR INSPECTIONS, CALL (509) 688-0054
Project Address: S.1/h C a S ' Permit Use:
Owner:
Phone (Daytime Contact):
Mailing Address:
City
State
Zip Code
Contractor: License #: Phone #:
Mailing Address:
Zip Code
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: ��
DESCRIPTION OF WORK
# OF
UNITS
X
COST
-
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
a.
X
06.00
=
1) . CSU
2
URINALS
X
06.00
=
3
TUBS
Z
X
$6.00
=
/ Z • 00
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
1
X
06.00
=
V , Q0
5
SINKS
LAVSIBASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
`
J
X
$6.00
30 Or?
'
6
DISHWASHER
1
X
$6.00
=
G • aO
7
CLOTHES WASHER
X
06.00
=
8
GARBAGE DISPOSAL
1
X
06.00
=
/
f✓ • 00
9
WATER SOFTENER
X
06.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
06.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
40, , co
12
ROOF DRAINS/OVERFLOW DRAINS
X
$6.00
=
13
FOUNTAINS, DRINKING
X
$6.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
INSTALLATION, ALTERATION,
REPAIR, REVERSALS
X
$6.00
=
zoo
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
06.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER,
HOSE BIB, STEAMER, PROOFER,
CARBONATOR, SWAMP COOLER
3
X
06.00
=
1 goo ‘ 00
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
06.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
$6.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING FIXTURE
X
$6.00
=
METHOD OF PAYMENT:
0 CASH 0 CHECK ❑ VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
$35.00
TOTAL. PERMIT FEE DUE:
/37 . a)
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: ��
ADDRESS
ZONE -0
ROAD WIDTH
FRONT
COMMENTS
REVIEWED
-k Or( c+Fo) S vc
75,/',
44e Ki
This site plan is being
obtaining a building perm
representation of the
lines/dimensions, curb 11
have been identified.
bodies of r, steep
for the purpose of
and is a true and correct
Ali known property
structures and easementi
indicated are wetlands,
aflar critical areas.
�..
Signed.
Date:
n
M
z
1�
(:55 0 "
/<-
5e7 Mur TO
SCczN t wrOi y
fO
71-`11
7.5c'
do/ 5. 5ftEL.LGv LA- E
for 5 Loc�_Z
1833 f' ` iTLuiNy ENUCLi C-7--
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