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2001, 05-29 Permit App: 01003995 Remodel, Mechanical FixturesProject Number: 01003995 Inv: 1 Application Date: 5/29/01 Page 1 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: INSTALL EGRESS WINDOW, .MFTAT Cu7MNFY AND 1 GAS RANGE, PIPING Setbacks: Front Site Information: Left: Plat Key: 001401 Name: KRUEGER'S 1ST ADD Right: Rear: Parcel Number: 45021.0303 Block: SiteAddress: 4620 N ST CHARLES RD VERADALE, WA 99037 Location:: VER Zoning: UR -3.5 Water District: Area: 0 Sq Ft Nbr of Bldgs: 0 Review Information: Department BUILDING Permits: Urban Residential 3.5 Width: 0 Nbr of Dwellings: 1 Contact: CUMMINS, GARY & LYN Address: 4620 N ST CHARLES RD C - S - Z: SPOKANE, WA 99216 Phone: (509) 928-7280 Group Name: Project Name: District: H Lot: Owner: Name: CUMMINS, GARY & LYN Address: 4620 N ST CHARLES RD SPOKANE, WA 99216 Hold: ❑ Depth: 0 Right Of Way (ft): 50 Hold Reasons: Permit Conditions: Plan Review Project Number: 01003995 Inv: 1 Application Date: 5/29/01 Page 2 of 2 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Building Permit Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 000000, 00 000000 Building Characteristics Const Category: Remodel Group: R-3 Type: VN Nbr Of Dwellings: Occupant Load: Building Height: Stories: Bldg W x D: x Building Sq Ft: Sprinklers: El Req Parking: Handicap Parking: Critical Materials: El This Application: Total Project: Description Grp Type Notes So Ft Valuation Sri Ft Valuation RESIDENCE R-3 VN REMODEL 0 $350.00 0 $350.00 Item Description RESIDENTIAL VALUATION STATE SURCHARGE RESIDENTIAL SURCHARGE Totals: 0 $350.00 0 $350.00 Units Unit Desc 1 Y OR BLANK 1 Y OR BLANK 1 Y OR BLANK Permit Total Fees: Mechanical Permit Fee Amount $35.00 $4.50 $7.70 $47.20 Contractor: OWNER Firm: OWNER Address: 0 Phone: (000) 000-0000 000000, 00 000000 Item Description Units Unit Desc WOOD/PELLET STOVE/INSERT 1 NUMBER OF GAS PIPING 1 # OF UNITS RANGE 1 NUMBER OF Payment Summary: Operator: DMD Permit Type Building Permit Mechanical Permit Permit Total Fees: Printed By: DMD Print Date: Fee Amount $47.20 $36.00 Invoice Amount $47.20 $36.00 $83.20 Notes:.: .SIM_- ._ Eh-. $83.20 Fee Amount $25.00 $1.00 $10.00 Amount Paid $0.00 $0.00 $0.00 $36.00 5/29/01 Amount Owing $47.20 $36.00 $83.20 PROJECT APPLICATION WORK SHEET SPOKANE COUNTY DIVISION OF BUILDING & CODE ENFORCEMENT 1026 WEST BROADWAY AVENUE SPOKANE, WA 99260 509-477-3675 SPECIFIC SITE INFORMATION Street Address: (o a1/40 , - CiAcv,, u _.n 9 _ y, �) G t Assessor's Tax Parcel Number(s): [�C Xl.G•1` t Legal Description: Project Description: J,,QJ 1r AA. newise..i � C( f 1.tA.� >yt.v� 1Wte.( .C—LM1Yvu , ( ),'YL7S J U f� , Building Permit O Change in Use O Grading O Manufactured Home Permit 0 Relocation O Sign O Tenant (New/Change) O Other OWNER/APPLICANT INFORMATION El Indicate who should be contacted regarding this project ❑ Owner Phone: '2 - 7:Z? 0 Fax: 0 Applicant Si rrYw.._ 0.4.vy Mailing Address: Phone: j Fax: Mailing Address Ci , State, Zip v1.9--) 0 aL, g 'IDA (o Ciry, State, Zip ❑ Contractor , OYv .L 0—A.4..1"4„.' 1, ,) Phone Fax ❑ Architect/Engineer Phone Fax Mailing address Mailing address City, State Zip City, State Zip WA State Contractor license i Contact name: PROJECT INFORMATION Building height to peak ildi-tvC Dimensions ' A/ f Occupanc1 group ., Cosi of pr�ect ` 04,1 N of stories Total habitable space Construction type Main floor sq. h. 1t 1g8 2nd floor sq. h_ Garage sq. ft_ Unfinished basement sq. h_ Heat source (electric, gas, etc.) Finished basement sq. h. 1,d ea Deck/ sq. ft. Width: Year: Length: What is the square footage of the sign face? How high is the sign? Make: # of signs Area of existing signs 0 Concrete 0 Welding 0 Bolting 0 Reinforcement ADDITIONAL SITE IN Are there structures on the property? 14 Yes 0 No Ifyes, identify on site plan What is the current property size? (square feet or acres) 111— G LAI - Is any part of the property within 250 feet of a shoreline? If yes, identify on site plan O Yes SC No What is the current use of this property?n • at >ti`� Is your property in a designated wildlife habitat area? 0 Don't know O Yes No Will the site be se ed 4a septic s stem? Rt Yech 0 No Is any pan of the property within a 100 yr flood plain? If yes, identih, on site plan O Maybe 0 Don't know O Yes el\10 Are or will there be wells located on the property? Ifyes, identify on the site plan 0 Yes No Are there any wetlands, streams or ponds within 200 feet of the property? Ifyes, identify on site plan 0 Yes til.No Is there evidence of fill or excavation on the property? 0 YesNo Are there slopes greater than 30% on the property?(09 ft rise in 100 ft) ( / %) 0 Yes Ar No Are critical or hazardous materials used or stored on sit'? 0 Yes f No DEPARTMENT USE ONLY Due Received Staff Representative - METHOD OF PAYMENT VISA ❑ CASH ❑ CHECK ❑UMW ❑ ., ICC VE` FAXED PERMITS WILL ONLY BE ACEPTED WITH PAYMENT OF A MAJOR CREDIT CARD DATE: BANKCARD NUMBER: EXPIRES: AUTHORIZED SIGNATURE: SUBTOTAL z Hr r INLSIUM P RMfr �r ass SA EQW 1(S'A AIsL Ti4$i'QBXI E CUUNTY iikl1T(E R , MECHANICAL PERMIT APPLICATION PROJECT �T/� , ADDRESS: 76 �G% i� •--'/ C//' C - PERMIT USE: OWNER: 62,4/'Y 4YV 6'64'',/'/77/7/---C-9:qF- PHONE (Daytime Contact): 72E(c MAILING ADDRESS: 4--/(,,20 l(J cT c(-4,(,(7 cpaeiC2/t vy4' /(.2- & (Street) (City/State) (Zip) CONTRACTOR: i,/c? Dl�//(/ '' LICENSE: MAILING ADDRESS: PHONE: = OR < 100,.000 (Street) (City/State) (Zip) Spokane County Division of Building & Code Enforcement 1026 West Broadway Avenue * Spokane, WA 99260-0050 Telephone No. (509) 477-3675 * Fax No. 477-7198 * TDD No. (509) 477-7133 DESCRIPTION OF WORK # OF UNITS MULT1- pa ByD COST/ UNIT EQUALS AMOUNT B02 FUEL BURNING APPLIANCE = OR < 100,.000 X $12 = $ B03 FUEL BURNING APPLIANCE > 100,000 X $15 — $ B04 UNLISTED APPLIANCE (ADDITIONAL CHARGE) = OR <400,.000 X $50 $ B04 UNLISTED APPLIANCE (ADDITIONAL CHARGE) >400,000 X $100 — $ B06 USED APPLIANCE (Must meet WSEC's min. AFUE rating) = OR <400,.000 X $50 = $ B07 USED APPLIANCE (Must meet WSEC's min. AFUE rating) >400,000 X $100 $ B08 BOILER/REFRIGERATION 1-100M BTU X $12 — $ B09 ;; BOILER/REFRIGERATION 101-500M BTU X $20 — $ B10 BOILER/REFRIGERATION 501-1,000M BTU X $25 — $ B11 ` BOILER/REFRIGERATION 1,001- 1,750M BTU X $35 — $ B12 ` BOILER/REFRIGERATION + 1,750M BTU X $60 — $ B13 GAS LOG, GAS INSERT, AND/OR GAS FIREPLACE - X $10 — $ B14 RANGE / X $10 — $ B15 DRYER - X $10 — $ B16 FUEL BURNING WATER HEATER - X $10 — $ B17 MISCELLANEOUS FUEL BURNING APPLIANCE - X $10 = $ B18 GAS PIPING (ea. Outlet) - / X $1 = $ B19 DUCT SYSTEMS - X $10 — $ B20 VENTILATING FANS - X $10 = $ B21`'. AIR HANDLER (DOES NOT include duct systems) — OR <10,000 CFM X $12 — $ B22 AIR HANDLER (DOES NOT include duct systems) > 10,000 CFM X $15 — $ B23 EVAPORATIVE COOLERS - X $10 — $ B24 TYPE I HOOD - X $50 = $ B25 TYPE II HOOD - X $10 — $ B26 HEAT PUMP/AIR CONDITIONER 0-3 TONS X $12 = $ B27, AIR CONDITIONER 3-15 TONS X $20 — $ B28 AIR CONDITIONER 15-30 TONS X $25 — $ B29 AIR CONDITIONER 30-50 TONS X $35 = $ B30 AIR CONDITIONER +50 TONS X $60 — $ B31 LPG STORAGE TANK - X $10 $ B32 WOOD OR PELLET STOVE/INSERT - X $25 $ METHOD OF PAYMENT VISAµ SUBTOTAL PLUS PROCESSING FEE $ 25.00 - _a • CASH CHECK • .11111111111 • : ■ FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT OF A MAJOR CREDIT CARD EXPIRES: DATE: BANKCARD AUTHORIZED TOTAL PERMIT FEE DUE MINIMUM.PERMIT FEE IS $35.00 PLEASE MAKE CHECKS PAYABLE TO SPOKANE COUNTY PERMIT CENTER NUMBER: SIGNATURE: Spokane County Division of Building & Code Enforcement 1026 West Broadway Avenue * Spokane, WA 99260-0050 Telephone No. (509) 477-3675 * Fax No. 477-7198 * TDD No. (509) 477-7133