HomeMy WebLinkAbout2004, 02-17 Permit App: BLD-04-03560 Pool.000Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILD/NG DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
1
STREET ADDRESS: 4 O Q SUr J `1 V 4-4-i -
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
14r\ C�12- w&, 6
PERMIT DESCRIPTION: S(,aim,u.,,,v{ i.)02_
CI BUILDING PERMIT CI CHANGE IN USE O GRADING
RELOCATION SIGN D TENANT
.0 MANUFACTURED HOME •
ItOTHER.
OWNER / APPLICANT INFORMATION
0 OWNER: ,b°k!{./J 44oc re_
�Z
® APPLICANT: P( -)CC' LDO14.41 I/) 6-,
PHONE: S93 - /-a6S- FAX: PHONE: FAX:
ADDRESS: (4 g0c- p SUN/`t V A9 LS/O(Llh" y -CADRESS:
® CITY,STATE, ZIP YiZ/4
CONTRACTOR: POOL- 030“-t-19 1' r .
PHONE: gag - b" FAX:
ADDRESS: (3 5-Z``' 5f' J L sfotL,9r v
CITY,. STATE, ZIP 99Zjt
WA ST CONTRACTOR LICENSE # d " OL -(. i 1 - X 2'{ j C/
ARCHITECT:
PHONE:
CITY, STATE, ZIP
FAX:
ADDRESS•
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
RIGHT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
STRUCTURES ON PROPERTY: FINISHED BASEMENT:
CRITICAL AREAS: GARAGE:
CURRENT PROPERTY SIZE: COVERED DECK:
CURRENT PROPERTY USE: DECK:
CURRENT SEPTIC USE:
CURRENT WELL USE:
IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
RELOCATION
FIRE SAFETY
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER:
PAINT BOOTH:
FIREWORKS DISPLAY:
FIRE ALARM:
TENT:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
° BOLTING ®CONCRETE ® REINFORCEMENT
FIRM NAME:
INSPECTOR(S):
PHONE:
® WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES 0 NO
IS PUBLIC WATER AVAILABLE: ® 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: ® YES 0 NO PSSA: ® YES 0 NO
IF YES: COUNTY CITY
DATE:1
STAFF:
METHOD OF PAYMENT:
CASH CHECK
VISA
BANKCARD ; EXP/RES: VIN #
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
*lane
,,,,.*Valley
Mechanical Permit Application
11707 Eavt Sprague Avenue, Suite 106 509-688-0036 - Phone
Spokane Valley, WA 99206 509-688-0037 - Fax
For Inspections, call 509-688-0054
PROJECT
ADDRESS: 9 ovs (.% s l)/twy ✓h -L f
PERMIT
USE:
OWNER: -D6'IZ Li..- SNAS)40 c.- Z &_
PHONE (Daytime Contact): gs3 _ (Z6S
MAILING ADDRESS: Li g O - N rJiaLt V - - £
s QA; iookl1 ✓ALt, i L.i ri- 9 c .z, 4
(street) (city/state) (ZIP)
CONTRACTOR:
FOUL., t)..) OC -o \N C ,
LICENSE #: po-OL. "(00 i _..rail c
PHONE #:
bS j
MAILING ADDRESS:
135.24 e_ . e u�
(0k,1Qt ,wa- Y4' -Z.(6
FUEL BURNING APPLIANCE
(street) (city/state) (ZIP)
METHOD OF PA
❑ CASH ❑ C
DATE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
8 OF UNITS
X
COST
EQUALS
AMOLIIVT
1
FUEL BURNING APPLIANCE
- OR < 100,000
X
$15
-
2
FUEL BURNING APPLIANCE
> 100,000
r
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
-
X
$10
-
13
RANGE
-
X
$10
-
19
DRYER
-
X
$10
-
15
FUEL BURNING WATER HEATER
--
X
$10
-
16
MISC. FUEL BURNING ADPL.
-
X
$10
-
17
GAS PIPING (ea. Outlet)
-
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
510
-
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
535
-
29
AIR CONDITIONER
+50 TON
X
$60
-
30
LPG STORAGE TANK
-
X
510
-
31
WOOD OR PELLET STOVE/INSERT
-
X
$10
-
32
WOOD STOVE - FREE STANDING
-
X
525
-
KENT
VISA',ire , ,-` '
_ _ _ •--. a+w®
SUBTOTAL:
PLUS PROCESSING FEE:
$35.00
TOTAL PERMIT FEE DUE:
EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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SCALE POOL DRAWING
FOR: SPECIFICATIONS:
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