1993, 03-15 Permit App: 93001473 Remodel, Reroof Spokane County
DEPARTMENT OF BUILDINGS
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
INFORMATION WORKSHEET
PARCEL NUMBER: / n
STREET ADDRESS: / O 2 6 S 1' ►n ; t✓;
CITY/STATE/ZIP: ���
SUBDIVISION:
BLOCK: LOT: ZONE: DISTRICT:
LOT AREA: F/A: WIDTH: DEPTH: R/W:
I OF BUILDINGS: # OF DWELLINGS: WATER DISTRICT:
OWNER: fa l e Z S a " . r c PHONEkee1) - (72 11 - .SG'7y
MAILING ADDRESS: / 2 o
CITY/STATE/ZIP: ' ' -� G✓�
CONTACT: PHONE:( 7 - 72 - SI
SETBACKS: - FRONT: LEFT: RIGHT: REAR
• , ,
PERMIT USE: s4
( 8-y1
BUILDING INFORMATION
CONTRACTOR LICENSE NUMBER:
1
CONTRACTOR: PHONE: - -
MAILING ADDRESS: 0 . 0p
ARCHITECT/ENGINEER:_ PHONE: - -
MAILING ADDRESS:
NEW: REMODEL: ADDITION: CHANGE OF USE:
DWELL UNITS: OCCUPANT LOAD: BUILDING HGT: STORIES:
BUILDING DIMENSIONS: X (WIDTH X DEPTH) SQ. FT. :
REQUIRED PARKING: # HANDICAP: SPRINKLERED: CRITICAL MATERIAL:
PLEASE PROVIDE THE FOLLOWING INFORMATION FOR ENERGY CODE COMPLIANCE:
SPACE HEATING TYPE (Check One)
FORCED AIR ELECTRIC ELECTRIC BASEBOARD OR WALL MOUNT
FORCED AIR GAS HEAT PUMP
PROPANE OTHER:
FLAT CEILINGS R DOORS U.
VAULTED CEILINGS R WINDOWS U
ABOVE GRADE WALLS R GLAZING AREA
BELOW GRADE WALLS R TOTAL FLOOR AREA OF HEATED SPACE:
FLOOR R
SLAB ON GRADE R FURNACE EFFICIENCY RATING
PLEASE INDICATE ON YOUR PLANS:
The location of the radon vent, and the location of the vent fan area.
**************************************************** **************************
SQUARE FOOTAGE:
MAIN FLOOR
SECOND FLOOR
BASEMENT - FINISHED
UNFINISHED
GARAGE
CARPORT
DECKS
ADDITIONAL AREAS:
******************************************************************************
LENDER/BOND HOLDER: .
ADDRESS
CONTACT PHONE
MECHANICAL PERMIT APPLICATION FORM
.linfomaation Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
MECHANICAL WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION OF UNITS UNIT =AMOUNT
ELECTRIC/DUCTWORK(SEPARATE SYSTEMS) x 10.00 =
_W000ST INSERT .............. x 25.00 =
GAS WATER HEATER x 10.00 =
x1
2.00 =
GAS EQUIPMENT+100,000 BTU DUCTWORK) x 15.00 =
1.
x 00 =
BOILER/REFRIG 1-100M BTU x 12.00 =
x20.00 =
<t�: `I��::�:�>> ill:�<1��>�:5t3►I3�A�C.:..'1.�.:..:::::::::::::::::.::::..::::::::.........:..:::::::.:
BOILER/REFRIG 501-1,000M BTU x 25.00 =
eQILEF3/::Sl`(�I:G
� WAO4V 'f:150 ��
x35.00 =
BOILER/REFRIG +1,750M BTU x 60.00 =
2. =
H ><:f'iJMI:'::';�AIR :: Ibt'CIWe>�:I�:..:.�.::::QNS.:::.;:.;:.;:.;>;»:.;;;:.;:<.;.
xi 00
HEAT PUMP&AIR CONDITIONER 3-15 TONS x 20.00 =
x 25.00 =
HEAT PUMP&AIR CONDITIONER 30-50 TONS x 35.00 =
: 60.00 =
x 00
:HEA'I:f?UMP �:1�th1 '?t'I`l�w Erb;f ::TCS,;;:�:;;:.;:.;;;::;,;;;;:.;:.::.::.
6
VENTILATING FANS x 10.00 =
x 10.00 =
TYPE I HOOD (PER 12' OR 12' PTN. OF HOOD) x 50.00 =
0
x 10.00 =
CLOTHES DRYER x 10.00 =
x1 .00 =
...NSE.............. .... .. ..
GAS LOG x 10.00 =
MisoEltA1geouvINOrtOVEREb ELSeWHtgI< >:» : x 10.00 =
UNLISTED GAS APPLIANCE<400,000 BTU x 50.00 =
x100.00=
USED APPLIANCE<400,000 BTU x 50.00 =
x1 00.00=
AIR HANDLER<10,000 CFM x 12.00 =
5
x 15.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE _$
SIGNATURE
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675
•
PLUMBING PERMIT APPLICATION FORM
Information Worksheet
JOB STREET ADDRESS:
CITY/STATE/ZIP: PARCEL NUMBER:
OWNER: PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
NUMBER X EACH
DESCRIPTION •
OF UNITS UNIT =AMOUNT
TOILETS I x 6.00 =
� x 6.00 —
SHOWERS x 6.00 =
x 6.0 =
. . ...................................................
KITCHEN SINKS x 6.00 =
DS =
.....................................................................
.;:.:.::....:...:...:............................................................................
........................................................................;:_:;_>:;� 6.00
GARBAGE DISPOSAL x 6.00 =
x 6.00 =
.. ......::..........................................................:::.:::::::::.:::::...:............................................
UTILITY SINKS x 6.00 =
x 6.00 =
.::....:.:..:::.....:.:.:::.::.:.::::...::....::...::.:..::.:::.:::.:...:.........................................:...:................
FLOOR DRAINS x 6.00 =
x 6.00 =
....::.........:::..:.:.:......::...........................................................................................................
BAR SINKS x 6.00 =
=
x 6.00
.. ..
LAWN SPRINKLER— FOR EACH BACKFLOW DEVICE x 6.00 =—
.EVVP►.Ca.E.;Iw.J...E�Tf��;:;:.:;::;�:.;:.;:.;:.;:.;>:::.;;;;:::�>:<:;::<,<::::<:::>::>:::<:::::>::>::»:>;:::::�.:.;:::<::::::<::>:.;:.;:.:;:.::.: x 6.00 =
WATER SOFTENER x 6.00 =
x 6.00 =
DRINKING FOUNTAIN x 6.00 =
SUBTOTAL $
PLUS: PROCESSING FEE +$ 25.00
NOTE: MINIMUM PERMIT FEE IS$35.00 EQUALS: TOTAL PERMIT
FEE DUE =$
SIGNATURE
Spokane County Division of Buildings
•
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675