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2003, 10-21 Permit App: BLD-03-02841 Additionj� STREET ASSESSOR'S TAX PARCEL NUMBER LEGAL DISCRI PERMET DESCRIPTION: 04UILDING PST . [3RELKATIUN PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUN/TYDEVELOPMENT BUILDING DIVISION 9 9707 East Sprague A ve Ste 906 Spokane Valley, WA 99206.... Phone: (509)688-0036 Fax- L509)688-0037 REQUIRED SITE INFORMATION O C$ANGE -IN USE - ]n.GP_AD1+rG U.MA UFACTURED HOME [2SIGN []-TENANT [-OT R... OWNER / APPLICANT INFORMATION ®OWNER: �%(✓ ® L APPLICANT: PHONE: FAX: PHONE _- l J� FAX: ADDRESS: ADDRE5 CITY,STATE, ZIP 13 ® CITY, STATE, ZIP CONTRACTOR: ARCHITECT.: PHONE:� _0 % 7 3 FAX PHONE: FAX: ADDRES G/•- rC[�' -� �' ADDRESS: CITY,.STATE, ZIPWj� ,?.2 CITY, STATE, ZIP WA ST CONTRACTOR LICENSE #j: �C I CkZ ;e CONTACT: PERMIT/BUILDING INFORMATION COST OF PROJECT: BUILDING HEIGHT TO PEAK: � 2 - BUILDING DIMENSIONS:. -Z X.�X "NUMBER OF STORIES: ;Z NUMBER of BEDROOMS:__ FLANKING SETBACK: f-xl • -=-1 r FRONT SETBACK: /_ REAR SETBACK: L X.'s l . LEFT SETBACK: RIGHT SETBACK:1 c i �- 30% SLOPES ON PROPERTY: OCCUPANCY GROUP: CONSTRUCTION TYPE: STRUCTURES ON PROPERTY: CRITICAL AREAS: CURRENT PROPERTY SIZE: CURRENT PROPERTY USE: CURRENT SEPTIC USE: CURRENT WELL USE: IMPERVIOUS SURFACE AREA: MAIN FLOOR SQ FT: 2ND FLOOR SQ FT:- S 7. UNFIN BASEMENT: FINISHED BASEMENT: GARAGE: 5 % Z— COVERED DECK: DECK: MANUFACTURED HOME SIGN WIDTH: YEAR: MANUFACTURER: LENGTH: PIT SET: SQ FT OF SIGN: # OF SIGNS: TYPE OF SIGN: HEIGHT Or SIGN: AREA OF EXIST SIGN: RELOCATION FIRE SAFETY 'PREVIOUS ADDRESS: PROPOSED USE: FIRE SPRINKLER: PAINT BOOTH: FIREWORKS DISPLAY: BLASTING: WA STATE NON-RESIDENTIAL ENERGY CODE FIRE ALARM: TENT: DATEITIME: PLANS EXAMINER: PHONE: FAX: ADDRESS_:. CITY, STATE, ZIP INSPECTOR: PHONE: FAX: CITY, STATE, ZIP SPECIAL INSPECTIONS ® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): .BUILDING STAFF USE ONLY IS PUBLIC SEWER. AVAILABLE: ® YES ® ANO IF YES: © COUNTY ® CITY IS PUBLIC WATER AVAILABLE: ® YES ® NO IF. YES, WHICH WATER DIST/IRR: IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES a NO IS THE PROPERTY LOCATED WITHIN ASA: ® YES 13 NO PSSA: ® YES ® NO DATE: MC I PfVV U/- PA rM&NI CASH CHECK SANKCARD 47EXP/R S,' V/NAS AUTHORIZEDSIGNATURE *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD IETHOD OF CASH ATE: tlTY Oi'� Spokan�e ,;oOValley 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 DESCRIPTION DETAILS PERMIT ADDRESS: �/ ��� 5`1.:-P1A , % EQUALS USE: 4AS ID .U'(/ f OWNER: C, �' WATER CLOSET, BIDETS PHONE (Daytime Contact): MAILING ADD SS: $6 - j/t� lam` Ey 2 URINALS (street) (city/state) (ZIP) C CT - LICENSE MAILING ADDRESS: ' PHONE #: . �• -��7 7 X $6 - (street) (city/state) (ZIP) PLUMBING FIXTURES ANKCARD NUMBER: UTHORIZED SIGNATURE: EXPIRES: DESCRIPTION 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 LAVSBASINS, BAR, FLOOR KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X- RAY, FOOD, PREP/CULINARY/MEAT X $6 - 6 DISHWASHER X $6 - 7 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 $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 IMISC. PLUMBING FIXTURE X $6 PAYMENT -1 CHECK ❑ E3 SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: ANKCARD NUMBER: UTHORIZED SIGNATURE: EXPIRES: C-IaTY 10 11707 East Sprague Avenue, Suite 106 509-688-0036 - Phone 3POJA a Spokane Valley, WA 99206 509-688-0037 - Fax �ValleyFor Inspections, call 509-688-0054 ,Mechanical Permit Application PROJECT ADDRESS: t/HCl L Sit . —74 (� s! 1` USE: _ OWNER " r Z PHONE (Daytime Contact): 3s—a21o3� MAILING AD RESS: $15 - 2 FUEL BURNING APPLIANCE > 100,000 X $19 - (street) (city/state) (ZIP) CONTRACTOR: 4 UNLISTED APPLIANCE (ADDITIONAL FEE) LICENSE #: X MAILING ADDRESS: PHONE #: • or <400,000 (street) (city/state) (ZIP) METHOD OF PAY ❑ CASH DATE: _ DESCRIPTION OF WORK # OF UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE • OR < 100,000 X $15 - 2 FUEL BURNING APPLIANCE > 100,000 X $19 - 3 UNLISTED APPLIANCE (ADDITIONAL FEE) = OR < 400,000 x $550 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- loom BTU X $15 8 BOILER/REFRIGERATION 101- 500M BTU X $28 - 9 BOILERIREFRIGERATION 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 - X $10 13 RANGE - X $10 - 14 DRYER - X $10 - 15 FUEL BURNING WATER HEATER - X $10 16 MISC. FUEL BURNINGAPPL. - X $10 17 GAS PIPING (ea. Outlet) - X $1 18 DUCT SYSTEMS _ X $10 - 9 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/ATR 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 $60 30 LPG STORAGE TANK - X $10 - 31 WOOD OR PELLET STOVEANSERT - X $10 32 WOOD STOVE - FREE STANDING - X $25 TIENT c -- SUBTOTAL: PLUS PROCESSING FEE: $35.00 TOTAL PERMIT FEE DUE: ❑ CHECK BANKCARD NUMBEIL AUTHORIZED SIGNATURE: EXPIRES: APPROVED BY .' .�..<�. 1 77 � G i b A y22,x o s �dJ Lcc�•� _ .— d-Cll 6