2003, 04-28 Permit App: BD03-205 Residence iLIF'R 25 2003 13:32 FR TO 9268004 P.02472
City of Com'
SPOKANE VALLEY fay 1.„, 0037
PERMIT# _
BUILDING PERMIT APPLICATION
Box I OwNBR Jon D. Hawley JOB LOCATION
OWNER'S ADDRESS CITY PHONE (509) 921-9T94
P.O. Box 141423, Spokane, WA 99206
DESCRIBE sOB
r (Main F1OUL)- Family Re3ideace
THISPROPERTYIS OWNED BY:SINGLE/MARRIED Married •
PARTNERSHIP CORP
=____
BOX 2 CONTRACTOR'S NAME PBI Construction, Inc. PHONE (509) 926-773+
CONTRACTOR'S ADDRESS P.O. Box 141257 cITY Spokane, WA 99214
CONTRACTOR'S REG.# PBICOI*033RQ EXPIRATION DATE 08/27/03
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
Jam----
BOX 3 CONTACT PERSON OFPROJECT PBI, Jon Hawley PHONE (5099) 926-7734
ADDREss P.O. Box 141257 CITY Spokane ZIP 99214
Yes—�s=�==M
BOX 4 SEWER AVAILABILITY Yes WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ 185,000 EXISTING BLDG.VALUATION$ N/A
BOX 6 PROPERTY TAX ACCOUNT NUMBER Parcel #45325.3003
LEGAL DESCRIPTION
Ponderosa 9th, Lot 3, Bl.k 1
(IF NECESSARY,PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE(Existing/ r�poeed) 1ST FLOOR 1319 /s f 2ND FLOOR 1181/ sf
3RD FLOOR II/a / OTHER / BASEMENT FINISHED n/a /
BASEMENT UNFINISHED n/a / DECK / GARAGE. /
CARPORT / TOTAL 2500/s f HEIGHT TO PEAK OF BUILDING 36 FT.
BOX 8 ( X) SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO.OF UNITS _) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ.Et
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ SQ.FT.
BOX 9 PLUMBING FIXTURES(Including rough-ins) 12 MECHANICAL APPLIANCES 2
PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS,HEATING AND AIR UNITS,FIREPLACE INSERTS,WATER HEATERS,CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS,BACK FLOW PREVENTERS,ET AL
BOX 10 Water Service meter size(if known)_ Also see BOX 4
BOX 11 Septic Tank—Not generally allowed in the City of Spokane Valley.For special circumstances contact
Your sewer purveyor and the Health District (See BOX 4)
BOX 12 Street use may require a'Street Use Permit'for sewer,water.Sidewalks,curb arts.Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT 10 THE BEST OF MY KNOWLE'GE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO"PERFO- • YFIL
WI)" FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT • _ DATE 04/28/03 (OVER)
Jon I . Haw
** TOTAL PI E.02 **
COTY t 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone -
N) kaile Spokane Valley,WA 99206 509-688-0037-Fax
.001g Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER -PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: -PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK F OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 ( X $15 = / 5-00
2 FUEL BURNING APPLIANCE >100,000 X $19 = i
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 595 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE - 1 X $10 = /0
13 RANGE - X $10 =
14 DRYER - I X $10 /0.00
15 FUEL BURNING WATER HEATER - , X $10 = /d
16 MISC.FUEL BURNING APPL. - X $10 =
17 GAS PIPING(ea.Outlet) - 3 X $1 - 3.(O
18 DUCT SYSTEMS - X $10 =
r
19 VENTILATING FANS - X $10 11 C.O(,)
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 - 10.tZ)
25 HEAT PUMP/AIR CONDITIONER 0-3 TON 1 X $12 = ' 2 .06
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 STOVE/INSERT - X $10 =
32 WOOD STOVE-FREE STANDING - X $25 =
SUBTOTAL: (/0
METHOD OF PAYMENT PLUS PROCESSING FEE: �$3bn96"—'
TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 iliniffii 0 '.__._.. = `
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
Sjr�/,, 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
;0•0*Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE It:
MAILING ADDRESS: PHONE It:
(street) (city/state) (ZIP) .
PLUMBING FIXTURES
DESCRIPTION DETAILS II OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS `7j X $6 - 1' '00
2 URINALS X $6 =
3 TUBS 2 X $6 - 12 .
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 = Co t0
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- �/ X $6 - SV
RAY,FOOD,PREP/CULINARY/MEAT U
6 DISHWASHER X $6 - LO,CO
7 CLOTHES WASHER X $6 - CO
8 GARBAGE DISPOSAL X $6 = Pe ,oD
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 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 - iyi
SWAMP COOLER �j (1�
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
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:
METHOD OF PAYMENT I C)
A tVast . PLUS PROCESSING FEE: $35.00
0 CASH ❑ CHECK 0 =MN ❑ E_._. .__`___`.
TOTAL PERMIT FEE DUE: 9
DATE: -- EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
APPROVED BY 2/i,44/1/2-9/9-kP
PA!VGWAY 1,4/writ
!-{oUSE TO OE CONG/2m61)
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