2003, 06-17 Permit App: BD03-645 Residence City of i
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER JOB LOCATION ` jC7 S, S (( (_ , �.
OWNERS ADDRESS CITY PHONE
DESCRIBE JOB I') C ( W
D
1
THIS PROPERTY
$iw5WNL 1SR �/M•r4.
D
PARTNERSHIP CORP.
44
BOX 2 CONTRACTOR'S
WOt .4 \�Z (1,0A.)"51- PHONE 9 LiZei
CONTRACTOR'S ADDRESS )(,5 Zo I✓.„ -3 cc,i2 -8gi t9-I CITY 1I A-u�1\--1-.C.,
CONTRACTOR'S REG.# C)...\'cs`jc.\04 c EXPIRATION DATE l 1 -Z ) -20Q<1
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT &I-- '.E P SCA-6v\-CTE- PHONE q 9-7-733
ADDRESS I(e)S 2_0 Ir,• SC; .T &I TTY U EARD 13-1--t- ZIP 0,q CJ 5')
BOX 4 SEWER AVAILABILITY S e S WATER AVAILABILITY `/e s
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
5140(&-y /4kR. Deveiami- .4,1)T /y 8 I 4
St 3o9 s l4e/% .ti2
la
(IF NECESSARY, PLEASE SUBMIT A SEPARATE P GE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE(Existing/proposed) 1ST FLOOR in/ 2ND FLOOR e /
3RD FLOOR ..IS' / OTHER / BASEMENT FINISHED -"er /
BASEMENT UNFINISHED - / DECK a / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING Ilg. FT.
BOX 8 06 SINGLE FAMILY (.><1 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) ( I' 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.
f VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY t< 0 L D E AND FURTHER THAT 1 AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFO), H' •11 FOR WHICH THE APPLICATION IS MADE.
�/�
OWNER/AGENT ,�/� J�'� DATE 6''1 9—d 3 (OVER
r-/ - 7
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
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
=IRE DEPARTMENT APPROVAL DISAPPROVAL
DATE
REMARKS
'UBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL
DATE
•
YPE OF JOB: NEW RESIDENCE RES. ADD/ALT NEW INDUSTRIAL INn Ann/At T
IEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS
IULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
1CCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
TOTAL SQ. FT. TOTAL VALUATION
JILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
ERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
)TAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
I-HER CHARGES AMOUNT DUE
JILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
��CITY I>E
E► 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
ne Spokane Valley,WA 99206 509-688-0037-Fax
,,,0,0 Valley
•Mechanical Permit Application
PROJECT
s/ / -PERMIT
ADDRESS: 3�14w�(! 5. 14,k 4- E::
OWNER: �J PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state)/ (ZIP)
CONTRACTOR: (9.d a rc�i�'1e /Te43LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state)
I, DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOlgs]T
1 FUEL BURNING APPLIANCE •OR<100,000 i X $15 /!j
2 FUEL BURNING APPLIANCE >100,000 X $19 l
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 t
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 - I X $10 /c)
15 FUEL BURNING WATER HEATER - I X $10 .
16 MISC.FUEL BURNING APPL. - X $10 /
17 GAS PIPING(ea.Outlet) - L X $1 =
18.DUCT SYSTEMS - _
19 VENTILATING FANS - S X $10 . 3 0 ^--.
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 U HOOD ) X $10 JD
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 .
26 AIR CONDMONER 3-15 TON _ X $20 .
27 AIR CONDITIONER 15-30 TON X $25 .
28 AIR CONDITIONER 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: `77
METHOD OF PAYMENT PLUS PROCESSING FEE: 17,35:430--
.
MOMr t TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 11111111RIN 0 :__._ .L.1..-.:.i
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
a7�cx ±/� 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
Spokane Valley,WA 99206 509-688-0037-Fax
Valley .
Plumbing Permit Application .
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
•
(street) (city/state) (ZIP)
3`IM
CONTRACTOR: L M 1 's PLa..' 13 no G LICENSE#:
MAILING ADDRESS: • PHONE#:
(street) (city/state) (ZIP) .
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UMTS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS Z X $6 - 1 2
2 URINALS X $6 - 1
3 TUBS ' X $6 - 7
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT _ I X $6 - { n
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, �f'
LAUNDRY,UTILITY,JANITOR,PHOTO;X- 2 X $6 -
RAY,FOOD,PREP/CULINARY/MEAT J
6 DISHWASHER X - l P
7 CLOTHES WASHER IX $6 -
8 GARBAGE DISPOSAL i X $6 - 1Q,
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 � ''t"
12 FOUNTAINS,DRINKING X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT;"PLUMBING REVERSALS _. ___
X $fi_
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, `/
STEAMER,PROOFER,CARBONATOR, 2 $6 +V
SWAMP COOLER J l 9
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
$6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X
17 SPRINKLER SYSTEM X $25
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 '
20 MISC.PLUMBING FIXTURE X $6
SUBTOTAL:
ETHOD OF PAYMENT "►►
' 'F, se'r{ d., PLUS PROCESSING FEE: $ 51J '
CASH . ❑ CI-IECK ❑ ammo ❑ L. ......_-_-::...i
TOTAL PERMIT FEE DUE:
ITE: EXPIRES:
NKCARD NUMBER:
'THORIZED SIGNATURE:
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