2003, 07-21 Permit App: BLD-03-02066 Additionrt'
Spa+0rjI�ane .
;Oovaky PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITYDEVELOPMENT
BUILDING DIVISION
1170 7 East Sprague A ve Ste 906
Spokane Valley, WA 99206
Phone:(509 688-0036 Fax.- 509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:445-1
� // A U'
ASSESSOR'STAXPARCEL NUMBER(S): "?.5 1 St C(-- /l -:?
LEGAL DISCRI
PERMIT DESCRIPTION:
-,�DULLDING PERMIT C CHANGE IN USE r-1 GRADING E MANUFACTURED HOME
O RELOCATION 13 SIGN (TENANT (OTHER -
OWNER /APPLICANT INFORMATION
® OWNER: FP -AA, /�- 2V U" Iq6�17`'- ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS:--E-69-2-t/ j1 rV all 'qy 2/'DDRESS:
CI ,STATE, ZIP CITY, STATE, ZIP
a CONTRACTOR: U) YI L° ® ARCHITECT:
PHON
ADDRESS:
CITY,.STATE, ZIP
WA ST CONTRACTOR LICENSE #
PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: �2, c 0d
BUILDING HEIGHT TO PEAK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
BUILDING DIMENSIONS: 1 �1- 'X 229' CONSTRUCTION TYPE: 1('490b
NUMBER OF STORIES: J
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:/ /V/�
RIGHT SETBACK: 131
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE: 12 5
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT: - 3�
2ND FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
MANUFACTURED HOME
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
RELOCATION
PREVIOUS ADDRESS:
PROPOSED USE:
SQ FT OF SIGN:
# OF SIGNS:
TYPE OF SIGN:
SIGN
HEIGHT OF SIGN:
AREA OF EXIST SIGN:
FIRE SAFETY
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
BLASTING:
WA STATE NON-RESIDENTIAL ENERGY CODE
FIRE ALARM:
TENT:
DATE/TIME:
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(Sl:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 13 NO IF YES: 0 COUNTY 13 CITY
IS PUBLIC WATER AVAILABLE: a YES ® NO IF YES, WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES a NO PSSA: ® YES 0 NO
DATE: 'I STAFF:
METHOD OF PA YMENT.-
0 ® ® ® x
CASH CHECK
BANKCARO#; EXP/RES.. VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
Sap (" � nem.`
.r;0Va.11.ey
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
-Mechanical Permit Application
PROJECT
ADDRESS:
PERMIT
USE:
OWNER
PHONE (Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR:
LICENSE 1:
MAILING ADDRESS: PHONE::
(street) (city/state) (ZIP)
METHOD OF PAY]
❑ CASH ❑ CF
DATE:
DESCRIPTION OF WORK
OF UNX
COST EQUALS AMOUNT
I FUEL BURNING APPLIANCE
. OR < 100,000
X
S15
2 FUEL BURNING APPLIANCE
> 100,000
X
$19
3 UNLISTED APPLIANCE (ADDITIONAL FEE)
OR < 400,000
x
S50 -
4 jUNLrSTED APPLIANCE (ADDITIONAL FEE)
> 400,000
X
5100
5 1 USED APPLIANCE (WSEC min. AFUE rating)
or < 400,000
X
S50
6 USED APPLIANCE (WSEC min. AFUE rating)
> 400,000
X
$100
7 BOILER/REFRIGERATION
1- loom BTU
X
S15
8 BOILER/REFRIGERATION
101- 5MM BTU
X
$28
9 BOILER/REFRIGERATION
501-1,000M BTU
X
$39
10 SOLLERIREFRIGERA77ON
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
-
X
$10
15 FUEL BURNING WATER HEATER
-
X
$10
16 MISC. FUEL BURNINGAAPPL.
-
X
$10 -
17 GAS PIPING (ea. Outlet)
-
X
$l
18 DUCT SYSTEMS
_
X
$10
19 VENTILATING FANS
-
X
S10
20 AIR HANDLER (DOES NOT include ducting)
- OR < 10,000CFM
X
$12
21 AIR HANDLER (DOES NOT Indude ducting)
> 10,000 CFM
X
$19
22 EVAPORATIVE COOLERS
-
X
$IO
23 TYPE I HOOD
-
X
S50
24 TYPE II HOOD
-
X
$10
25 HEAT PUMP/AIR CONDITIONER
0-3 TON
X
$12
26 AIR CONDITIONER
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
S60
30 LPC STORAGE TANK
-
X
$10
31 WOOD OR PELLET STOVEIINSERT
-
X
$10
32 WOOD STOVE - FREE STANDING
_
X
$25
BENT
r --
M.(1Z n n
SUBTOTAL:
PLUS PROCESSING FEE: $35.00
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER•
AUTHORIZED SIGNATURE:
EXPIRES:
'OD OF
iH I
Scrrt %rrr'
0aen
, ,;wAVa .ley
11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT
ADDRESS:
PERMIT
USE:
OWNER:
PHONE (Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR:
LICENSE t:
MAILING ADDRESS: PHONE #:
(street) (city/state) (ZIP)
PLUMBING FIXTURES
:ARD NUMBER:
)RIZED SIGNATURE:
DESCRIPT70N
DETAILS
# OF UNITS
X
COST
EQUALS
AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
X
$6
_
2
URINALS
X
$6
_
3
TUBS
`
X
$6
-
4
SHOWERS (PER TRAP)
BATH, STALL, ON-SITE BUILT
X
$6
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO, X-
RAY, FOOD, PREP/CULINARY/MEAT
`
X
$6
-
6
DISHWASHER
X
$6
7
1 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
R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
-
17
SPRINKLER SYSTEM
X
$25
18
INTERCEPTORS
GREASE TRAP, SAND TRAP, CHEMICAL
HOLDING TANK
X
$6
-
19
MEDICAL GAS per outlet
NITROUS, OXYGEN
X
$6
-
20
MISC. PLUMBING FDCMRE
X
$6
-
PAYMENT _
I
CHECK ❑ ❑ �.__-..
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
:ARD NUMBER:
)RIZED SIGNATURE:
Ul :L,1
EA5T* F
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