2003, 09-19 Permit App: BLD-03-02511 Remodel..#Vealley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106 5 5 5 ' (, 5
Spokane Valley, WA 99206 ( 1
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:
314 54P//e K.
ASSESSOR'S TAX PARCEL NUMBER(S): '715 '7 / . ; C.,(' Cf"T 6 1 L
J5'P
LEGAL DISCRIPTION: !-if) ` c �c f, P y o
PERMIT DESCRIPTION:
DDUIILDING PERMIT
Q RELOCATION
CI CHANGE IN USE 0 GRADING
LIMN Q TENANT
Ilk 4,
CI MANUFACTURED HOME
El OTHER
OWNER / APPLICANT INFORMATION
0 OWNER: a APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS:
I �/ CITY,STATE, ZIP
CI CONTRACTOR: /3 L1v1 , CDn S 1( -
PHONE:
a
ADDRESS:
CITY, STATE, ZIP
ARCHITECT:
FAX: PHONE:
FAX:
ADDRESS: p 0 (O'( ?dJL( Alewrvlav Lk 97025ADDRESS:
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE # CS, LIAO 9'<1'/< t l
CONTACT:
i-;
/' CITY, STATE, ZIP
V - AlCr4wlNev/
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /y ON
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP
CONSTRUCTION TYPE:
i
MAIN FLOOR SQ FT:
2ND FLOOR SQ FT: 1
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
/2t.9�
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:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE
FIRM NAME:
INSPECTOR(S):
® REINFORCEMENT
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: D YES CI NO PSSA: 0 YES 0 NO
1
1
DATE:
METHOD OF PAYMENT:
0
11.
STAFF:
CASH CHECK
VISA
BANKCARD #: EXPIRES: VIN#
AUTHOR/ZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
1
Spokane
41 .0 Valley
Mechanical Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS:
DESCRIPTION OF WORK
PERMIT
USE:
OWNER
X
PHONE (Daytime Contact):
MAILING ADDRESS:
AMOUNT
(street)
(city/state) (ZIP)
CONTRACTOR:
LICENSE #:
MAILING ADDRESS:
-
PHONE #:
2
(street)
(city/state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
8 OF UNITS
X
COST
EQUALS
AMOUNT
1
FUEL BURNING APPLIANCE
- OR < 100,000
X
515
-
2
FUEL BURNING APPLIANCE
> 100,000
X
519
-
3
UNLISTED APPLIANCE (ADDITIONAL FEE)
- OR <400,000
X
$50
-
4
UNLISTED APPLIANCE (ADDTITONAL FEE)
> 400,000
X
5100
-
5
USED APPLIANCE (WSEC min. AFUE rating)
- or < 400,000
X
550
-
6
USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
5100
-
7
BOILER/REFRIGERATION
1 - 100M BTU
X
515
=
8
BOILER/REFRIGERATION
101- 500M BTU
X
528
-
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
539
-
10
BOILER/REFRIGERATION
1001 - 1,750M BTU
X
157
-
11
BOILER/REFRIGERATION
+1750M BTU
X
595
=
12
GAS LOG, GAS INSERT, GAS FIREPLACE
-
X
510
-
13
RANGE
-
X
510
-
14
DRYER
-
X
510
-
15
FUEL BURNING WATER HEATER
-
X
510
=
16
MISC. FUEL BURNING APPL.
-
X
510
-
17
GAS PIPING (ea. Outlet)
-
X
51
-
/
18
DUCT SYSTEMS
-
X
510
-
19
VENTILATING FANS
-
X
510
-
20
AIR HANDLER (DOES NOT indude ducting)
- OR < 10,000CFM
X
512
-
21
AIR HANDLER (DOES NOT indude ducting)
> 10,000 CFM
X
519
-
22
EVAPORATIVE COOLERS
-
X
510
-
23
TYPE I HOOD
-
X
550
-
24
TYPE II HOOD
-
X
510
-
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512
-
26
AIR CONDITIONER
3-15 TON
X
520
-
27
AIR CONDITIONER
15-30 TON
X
525
-
28
AIR CONDRIONER
30-50 TON
X
535
-
29
AIR CONDITIONER
+50 TON
X
560
-
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
-
32
WOOD STOVE - FREE STANDING
-
X
525
-
1 NT
1I•_ ; .p^ t" '
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
CITY „
Sp
okane
,Walley
Plumbing Permit Application
11707 East Sprague Avenue, Suite 106 509-688-0036 Phone
Spokane Valley, WA 99206
509-688-0037 - Fax
PROJECT
ADDRESS: F5 (i7 5&e Ili CIC
DESCRIPTION
PERMIT
USE:
# OF LIMITS
X
OWNER: Gas? Inf,,,,e '
�7►'
EQUALS
PHONE (Daytime Contact):
-- s...2
) '-N
MAILING ADDRESS:
SSP
X
$6
-
(street)
(city/state)
URINALS
(ZIP)
X
CONTRACTOR: R _,_In,
rD ^S �-t„c i, � �
LICENSE #:
8(.0,/D
9 q 4 / /<
l
-
(?
MAILING ADDRESS:
ro (fax
if,-( IVe b
1/c
PHONE #:
'240S-2-
1114/
BATH, STALL, ON-SITE BUILT
95'02-5
X
$6
-
(street)
(city/state)
SINKS
(ZIP)
'
X
PLUMBING FIXTURES
IETHOD 0
] CASH
ATE: EXPIRES:
ANKCARD NUMBER
UTHORIZED SIGNATURE:
DESCRIPTION
DETAILS
# OF LIMITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
-
1
2
URINALS
X
$6
..�p
3
TUBS
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
-
(12
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
X
$6
-
6
DISHWASHER
X
$6
-
7
CLOTHES WASHER
X
$6,
-
8
GARBAGE DISPOSAL
X
$6
-
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
X
$6
-
12
FOUNTAINS, DRINKING
X
$6,
-
13
WATER PIPING/DRAIN-IN
WASTE, VENT, PLUMBING
REVERSAL
INSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6
-
14
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
$6
-
15
WATER USING DEVICE
ICE AND/OR COFFEE MAKER, HOSE BIB,
STEAMER, PROOFER, CARBONATOR,
SWAMP COOLER
X
$6
-
16
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE, AND
RP.B.P.D. FOR: VATS, TANKS, BOILERS
X
$6
-
17
SPRINKLER SYSTEM
X
$25
-
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FIXTURE
X
$6
-
PAYMENT
CHECK
VISA' ?lws at,
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
• �._-`:
TOTAL PERMIT FEE DUE:
5:3 0�
ATE: EXPIRES:
ANKCARD NUMBER
UTHORIZED SIGNATURE:
ESE PLANS MUST BE KEPT
THESE THE JOB SITE
REVIEWED FOR CODE COM
SP i ALL
B , , .�