2004, 09-08 Permit App: BLD-04-07590 Pool, Heater, Piping •
PY BUILDING PERMIT APPLICATION WORKSHEET.
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
evSpokane Valley, WA 99206
• .Phone: 509 688-0036 Fax: (509) 688-0037
•
REQUIRED SITE INFORMATION-• •
Street Address: O(5 S. • Aiekiitt • •
.
Assessor's Tax Parcel Number(s): • .
Legal Description: •
PERMIT DESCRIPTION: /61 X AvietAvo 6A ,i,m,,r4 , )c .
•
❑ Building Permit ❑ Change in Use • ❑ Grading 0 Manufactured Home
0 Relocation
0 Tenant Improvement ❑ Fire'Safety . ❑ Other
• OWNER/APPLICANT INFORMATION
•
❑ Owner: flick 1t i9 ❑ Applicant:
• Phone: 91y--a >o Fax: Phone: Fax;
Address: 403- s' ,Sirn - Address:
. StOgegit J q t (,✓A .. NU( •
. .
City • State Zip Code City .State Zip Code
❑ Contractor: • ✓-CC //JO/U(12 •
❑ Architect: •
Phone: -125-is— Fax: Phone: Fax:
Address: t3s�y ' Address:
1451ese.ze
City • State Zip Code • City• • State Zip Code
WA State Contractor License.#:,49 QL--iJi x2<lrcf Contact: •
•
PERMITIBUILDING.INF.OR ATION • •
HEIGHT TO PEAK • ' DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: ` eFLOOR SQ:FIG: UNFII4 BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG; . GARAGE SQ: FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: . • 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
SYSTEM?
lMANUFACTURED HOME
Width; • Length: Year:• Pit Set: - . •
Manufacturer: .
•
• • ' RELOCATION • . ' •
. : Previous Address: . .
Proposed Use: • . . .
FIRE SAFETY •
• Fire Sprinkler: # of Heads: •" Fire Alarm: Paint.Booth:
Tent: Fireworks DiPiay: Blasting: • • . . Da.te/Time:
Valuation: . Above/Underground Storage Tank Size: .
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE . • 1
Plans Examiner: Phone: • Fax:
Address: " . . . "
•
. City State • Zip'
• Inspector: Phone: • Fax: •
Address:
City State . Zip
' SPECIAL INSPECTIONS "
0 BOLTING •
❑ CONCRETE • 0 REINFORCEMENT 0 -WELDING
•
Firm Name: . . Phone:. Fax:
I nspector(s): •
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 to 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 Spbkane 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 wilt only be accepted with major bankcard).
❑ Cash ' ' 0 Check . d Mastercard . • 0 VISA • 0 Other
• Bankcard#: • . Expires:. •VIN#: .
Authorized Signature:
•
• MECHANICAL PERMIT APPLICATION
• ,\II11%,
*thane City of Spokane Valley Community Development Department
BuildingDivision
...„"Valley
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: '/Ol -S -Cu Ai IOC-AZ F1f 0 Permit Use: A 'Z2' //44A.evivo •si,,✓,mM,,,,,(
Owner: 13C,ra-,e.f.- M 6-14 N L44 Phone(Daytime Contact): tvdc /7 /7,7
Mailing Address: 40 S- S Su Ai DeRG ,0 .S�'W.0 VAcr.4.41 ''A- 9Y2
City State ..Zip Code
Contractor: g b-ei�J l NC__ License#: ,' -OL-w I it z$4 i c.i' Phone#: 94.f- 5-'S
Mailing Address: /3..,---21( ,£ .. Git L/-s__ .slZ,icstiC. v, Ve (,�i/'9
City State Zip Code
#OF I TOTAL
DESCRIPTION OF WORK - UNITS X COST = i AMOUNT
I
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $15.00 =
`-2l-FU€t_BUR A13PL, .: ••re.'.. I'',,.I• (o X $19.00 =
3 UNLISTED APPLIANCE(Additiional Fee) Equal to or less than 400,000 X $50.00 =
i
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
• USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-t00M BTU • X $15.00 = '
8 BONER/REFRIGERATION 101-500M BTU X $28.00
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOIL€It/REFRIGERA€ION More than 1,750M BTU X $95.00 = •
12 GAS LOG,GAS INSERT,GAS FIREPLACE • X $10.00 =
13 RANGE X $10.00 =
14 f DRYER X $10.00 =
15 FUEL BURNING WATER HEATER • X $10.00 = •
• 16 MISC.FUEL BURNING APPLIANCE X $10.00 = •
. 47GAS PIPING(each outlet) I X $1.00 =
18 I DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS X $10.00 =
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =
21 • AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $19.00 = '"
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE t HOOD X $50.00 =
24 TYPE II HOOD X $10.00 =
• 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
,
26 AIR CONDITIONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00
28 AIR CONDEMNER 30-50 TON X $35.00 = `
29 ' AIR CONDITIONER More than 50 TON X $60.00 =
30 . LPG STORAGE TANK X $10.00 =
3.1 WOOD OR PELLET STOVE/INSERT X $10.00 = •
32 ! WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
13CASH 0 CHECK 0 VISA Q MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: •
•
AUTHORIZED SIGNATURE:
0.
•
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