2003, 10-16 Permit App: BLD-03-02792 Residence crrE'OF 0011.1lir NIIlk . . ,
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41.0#ValleY
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BU/LD/NG D/V/S/ON
/- / ( � OO999707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
J Phone:`509)688-0036 Fax:(509)688--0037
REQUIRED SITE INFORMATION
STREET ADDRESS: ,J 3\ \ 'j J iriA a+\-- Lr\
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: k !�C\ v K. \ r' I Y1 A.< 1 pi.A.J
PERMIT DESCRIPTION: P `.3 Ci'zv< f,,c-c,c
DUILDING PERMIT a CHANGE IN USE a GRADING a MANUFACTURED HOME
D RELOCATION C SIGN °TENANT D OTHER
OWNER / APPLICANT INFORMATION i
C
® OWNER: 'V(::� I-_ }'\'f'`5V ® APPLICANT: skv-2 a-a-, CIRKt7c:G`.Li-Z
PHONE: FAX: PHONE: FAX:
ADDRESS: k\ 1 ke `1 c 2JC).6r.,2 " ADDRESS:
Cc 2.0t, CITY,STATE,ZIP CITY,STATE,ZIP
XONTRACTOR: ' \kw-2 CONA- ARCHITECT:
PHONE:-1 IA 1 2,T FAX: PHONE: FAX:
ADDRESS: 5- ‘-\`k -2-?,-.0 0 t s2t-e-,‘ • �\ . ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION 1
COST OF PROJECT: 3 k,c,00 ' 30%SLOPES ON PROPERTY: \`'3v MAIN FLOOR SQ FT: k q
0
BUILDING HEIGHT TO PEAK:QC; OCCUPANCY GROUP:CPS,X.A.k. 2ND FLOOR SQ FT: cC3\
r z JI
BUILDING DIMENSIONS: � i 5j CONSTRUCTION TYPE: �� '
N - (1,-,eiJ) UNFIN BASEMENT: V\i S
NUMBER OF STORIES: C STRUCTURES ON PROPERTY: �° FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: I\GAA- GARAGE:
-23
FLANKING SETBACK: t, CURRENT PROPERTY SIZE: f{V A se irk COVERED DECK: 35 51 i-
FRONT SETBACK: "l0 CURRENT PROPERTY USE: Q\0' V,) DECK:
ii Y/
REAR SETBACK: 1� CURRENT SEPTIC USE: (\C -
LEFT SETBACK: 1C CURRENT WELL USE: (V)V-42--
RIGHT
VG`(`42-RIGHT SETBACK: t3 IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME SIGN I
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY J
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS I
® BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: 0 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 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: 0 YES ® NO PSSA: 0 YES 0 NO
IDATE: I STAFF:
METHOD OF PAYMENT:
0 fa: ® rte' ® Y
CASH CHECK L. VISA
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
nnO 1� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Can Spokane Valley,WA 99206 509-688-0037-Fax
,,,,•Walley
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 5f \\ USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE I:
MAILING ADDRESS: -• PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 X ' $15 -
2 FUEL BURNING APPLIANCE r- >100,000 ' X $19
3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000 X $50 -
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 .
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X. . $50
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 .
8 BOILER/REFRIGERATION 101-500M BTU X $28 .
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 •
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE - I X $10 .
13 RANGE - I X $10 -
14 DRYER - I X $10 .
15 FUEL BURNING WATER HEATER - I X $10
16 MISC FUEL BURNING APPL. - X - $10 • -
17 GAS PIPING(ea.Outlet) - 5 X $1
18 DUCT SYSTEMS - X $10
19 VENTILATING FANS - X $10
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 .
22 EVAPORATIVE COOLERS - - X $10 •
23 TYPE I HOOD - X $50 .
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 CONDMONER 30-50 TON X $35 -
29 AIR CONDITIONER +50 TON X $60 -
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X • $10 -
32 WOOD STOVE-FREE STANDING - X $25 =
SUBTOTAL:
METHOD OF PAYMENTPLUS PROCESSING FEE: $35.00
Miiiii"S'. TOTAL PERMIT FEE DUE:
VISA0 CASH 0 CHECK 0 101811151 ❑ L___...__.
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Scrr4<x 01 11707 East Sprague Avenue; Suite 106 509-688-0036 Phone
j i ne - Spokane Valley,WA 99206 509-688-0037-Fax
.,,0%1ley
Plumbing Permit Application
PROJECTPERMIT
ADDRESi3\\ is`�VZ i,� USE:
OWNERCr \ n_ }- PHONE(Daytime Contact):
MAILING AD ESS: Y� XIS
. AC,) ' c 7-71L- 5 �.k C(4-26(e
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE It:
c3k i,.., 2-21-t° Sd Id s- ‘Q(----. CiAT O-i
(street) (city/state) (ZIP) '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 -
2 URINALS X $6 -
3 TUBS a X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT ( X $6
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X ' $6 =
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER ' X $6 =
7 CLOTHES WASHER I X $6 -
8 GARBAGE DISPOSAL I 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 -
73 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING REVERSALS X $6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS I X $6 `
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 FIXTURE X $6 -
SUBTOTAL:
ETHOD OF PAYMENT
UMW
' 'n'ast-�_,., : PLUS PROCESSING FEE: $35.00
CASH ❑ CHECK ❑ NM= 0 �._,1:__":; -
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
'.NKCARD NUMBER:
JTHORIZED SIGNATURE:
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