2004, 03-23 Permit App: BLD-04-03860 Remodeloesa,
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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:
4-7 s ,57w IEy Gk th
Assessor's Tax Parcel Number(s): 452-q-/ , 2._(G0 -
Legal Description:
She Lk 1-PIAD 1a-f5RIk
PERMIT DESCRIPTION: FI' 1 I S rl Ec{3 e #YJ E'L2 -f-
Building Permit
❑ Relocation
, 314ibr
❑ Change in Use ❑ Grading ❑ Manufactured Home
Fl Tenant Improvement ❑ Fire Safety n Other
OWNER/APPLICANT INFORMATION
Owner: C�ec re c Jlz
Phone: 97 0- SL Fax. 9zi -9776
Address: Pa a D.% 2
L b e'r•,ty Cake
City State Zip Code
Contractor: %2Qu
Phone: 728'-4.797 Fax:
Address: 11--3i E (c-{-11 /t -
/<'c�? W/9- 9z/e'
City
State Zip Code
WA State Contractor License #:HEeSEI2'i,4-P$
CCB T:154
Applicant: Mtt / Hen -eV
Phone:4-r9-92fi'-4797 Fax: 41-
Address: /¢3j- E Ave_
L/f- ?9 2C
State Zip Code
City
1K Architect: Ilii
Phone: 92 Z -73/11 Fax: 3ZS9-73
Address:
City
State Zip Code
Contact: frif rSey
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
/?.30
2"" FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
/r30
FINISHED BASEMENT SQ. FTG:
0
GARAGE SQ. FTG:DECK/COV.
7 �
PATIO SQ. FTG:
2`f
OCCUPANCY GROUP:
CONSTRUCTION TYPE:,HEAT
7I c/%ly/rt gPic cher
SOURCE:
Vaf
# OF BEDROOM,S:
. - _ + 3)
TOTAL HABITABLE SPACE:
r r 30
IMPERVIOUS SURF CE
COST OF PROJECT:
7, 5-010 ''
30% SLOPES ON PROPERTY:
`-SYSTEM?
'SEWER OR ON-SITE SEPTIC
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year:
Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
# of Heads: Fire Alarm:
Paint Booth:
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
❑ BOLTING ❑ CONCRETE
Firm Name:
111 REINFORCEMENT
Phone:
Inspector(s):
Fax:
❑ 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 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) 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 Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
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PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
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: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City
State Zip Code
Contractor: License #: Phone #:
Mailing Address:
City
State
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code
DESCRIPTION OF WORK
# OF
UNITS
X
COST
=
TOTAL
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6.00
=
Z
2
URINALS
X
$6.00
=
3
TUBS
X
$6.00
=
1
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR,
KITCHEN, LAUNDRY, UTILITY,
JANITOR, PHOTO, X-RAY, FOOD,
PREP/CULINARY/MEAT
X
$6.00
=
-�
/3
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
$6.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
$6.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH,
CONDENSATE
X
$6.00
=
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
=
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
X
$6.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK
VALVE, AND R.P.B.P.D. FOR:
VATS, TANKS, BOILERS
X
$6.00
=
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 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
7
PROCESSING FEE
$35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Zip Code