2004, 08-17 Permit App: BLD-04-07395 Residence BUILDING PERMIT APPLICATION WORKSHEET
'� a ment Department
City of Spokane Valley Community Development
Building
Division
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11707 E. Sprague Avenue, Suite 106
.....IValle. Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
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REQUIRED SITE INFORMATION - .
Street Address: --/ �-,7 i/ . A4 /AA,E
Assessor's Tax Parcel Number(s): 1'.. 41/ . /S2/O 74 /d , '/ / ,42z 41)--
,
- Legal Description: 0 d . k ,D/] /2
PERMIT DESCRIPTION: A4 1 (174 _/,'f1'/O//i/ - .
,Building Permit ❑ Change in Use ❑ Grading 0 Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety D Other
OWNER/APPLICANT INFORMATION
4121: Owner: 4_,:./1--7— ////'(/ /f,7', _ ❑ Applicant: .i�D /'L�vt�
Phone: 7. (2-%31f Flax: , i'SVC9 Phone:, .? rax:I -'41
9df ress'' /)D c= / dress' / /22 c �
C/ttx da� L.U�, I !dS 7 �x /4-/ A) 7
City State Zip Code City State Zip Code
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❑ Contractor: 5e1 /-C.• ❑ Architect:
Phone: Fax: Phone: Fax: '
Address: • Address:
•
City State Zip Code City - State Zip Code
WA State Contractor License#: " Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK j?
/ 4 / DIMENSIONS: a #OF STORIES:
5e" X
MAIN FLOOR TO SQ. FTGyrio ' 2'`"'FLOOR SQ. FTG. 7 UNFIt4 BASEMENTS e:
FINISHED BASEMENT .FTG; GARAGE SQ: FTG:/ -75 E DECKICOV. PA IO SQ. FTG:
Zd
OCCUPANCY GROUP: CONSTRUCT'•N xyi- . HEAT SOURCE;.--, �,
#OF BEDROOMS: TOTAL HABITABLE E SPACE: IMPERVIOUS.SURFACE AREA:
3 76
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWS OR ON-SITE SEPTIC
- �`�� , 'Y� EM?
-
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer: .
•
••
RELOCATION .
. Previous Address: .
Proposed Use:
FIRE SAFETY • J
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: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
0 BOLTING 0 CONCRETE 0 REINFORCEMENT ❑ WELDING
•
Firm Name: Phone:. Fax:
nspector(s):
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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 Valley 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) AU 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 • • Signature
•
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)_
❑ Cash ❑ Check 0 Mastercard . • ❑ VISA 0 Other
• Bankcard#: Expires: • VIN#:
Authorized Signature:
MECHANICAL PERMIT APPLICATION
4 s c tp r 0 iiiane City of Spokane Valley Community Development Department
BuiidingDivision
Valley 11707 E. Sprague Avenue, Suite 106
40, Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
r FOR INSPECTIONS, CALL(509) 688-0054
Project Addre s: 0 J- a _ & Lit/ Permit Use: A/4k/ , 4-' Q U G-Tk W
Owner: ..i Phoge(Daytime Contact):/
Mailing Address: /u/Z.o 21 r'-dae Gc - It/,a_.- 9a./6
City State Zip Code
Contractor: P 4 I/ License#: Phone#: _7; ,
Mailing Address:
City State Zip Code
#'OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 - I X $15.00 =
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 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 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 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
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) 3 x $1.00 =
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS 3 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 $19.00 =
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 11 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 =
METHOD OF PAYMENT: _ SUBTOTAL
❑CASH 0 CHECK 0 VISA EI MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
SITY la.
le City of Spokane Valfey Community Developmenr Departr'nent
BuifdingDivision
ley 11707 E. Sprague Avenue, Suite 106
400110P°
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
3 �,` 5 1-t&I. L E,y L k L. FOR INSPECTIONS, CALL(509)688-0054
Project Address: �� `' Permit Use:
...----
Owner: 16P lf(Z `GA Phone (Daytime Contact): o,r":. '7- 8
Mailing Address: E /`/ 12,0 ;Z / ?„4.:.',.4,6,,,-/c-, ,F_-t er4., 9 4-. L-7
// City State Zip Code
Contractor: Y40-rep License#: Phone#: *2--
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 =
2 URINALS U X $6.00 =
3 TUBS 3 X $6.00 =-
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6.00 =
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, 5 X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER / X $6.00 =
7 CLOTHES WASHER // X $6.00 =
B GARBAGE DISPOSAL ,�2" X $6.00 =
9 WATER SOFTENER ..0.- X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL /e `X $6.00 . =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,
/ X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS "--" X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS /J(J
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, / X $6.00 =
CARBONATOR,SWAMP COOLER ,
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: d'el- X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, ,*;'• X $6.00 =
CHEMICAL HOLDING TANK „
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN i. X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE } X' $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH ❑ CHECK 0 VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
, ..........
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