2003, 07-01 Permit App: BD03-727 Remodel City o f Phone 688-0036
SPOKANE VALLEY FAX 688-0037
Inspection 688-0054
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER ('czctti JOB LOCATION L3 ZZZ a -Q !�
OWNER'S ADDRESS ADDRESSa..,,r CITY T. PHONE - i - i
DESCRIBE JOB , , C� c; 14.4t( I� 4
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED X PARTNERSHIP CORP.
BOX 2 CONTRACTOR'S NAME E, /V PHONE
CONTRACTOR'S ADDRESS 176 44 7,d CITY l�
CONTRACTOR'S REG.# EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT Luffy ya, cc PHONE j 5--=zi7;
ADDRESS Gj 16 /I {' CITY 4:6(„WA4k9 ZIP TT
BOX 4 SEWER AVAILABILITY WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ '3€) 1)7(' EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTIO, 335-,Z5
CENSUS NUMBER LOT NUMBER 0\ ,"
BOX 7 BUILDING SQUARE FOOTAGE (Existing/ proposed) 1ST FLOOR / 2ND FLOOR /
3RD FLOOR /_ OTHER / BASEMENT FINISHED 39(i @ 5SQ
BASEMENT UNFINISHED / DECK / GARAGE /
CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING FT.463.
BOX 8 ( >SINGLE FAMILY ( ) NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE SQ. FT.
BOX 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES
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 cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT / ; DATE /- o�j (OVER)
s-vappbp 4-16-03
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa Mastercard ____ Expiration Date
Print the name of the Holder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND.ADD/ALT
NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPANCY TYPE OF CONSTRUCTION STORIES
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ _
BUILDING SQ. FT. �p =
BUILDING SQ. FT.
TOTAL SQ. FT. TOTAL VALUATION
BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Received
((,,��`��aro c�rTT�,d.��.',��" S4�rru 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
1.3 Bane Spokane Valley,WA 99206 • 509-688-0037-Fax
Valle T For Inspections, call 509-688-0054
•
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: / Zu 4 ���;6f,W USE:
OWNER: (Tra egeZe- 1PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) / .„4,,,,,, ;,to (ZIP) 1
CONTRACTOR: LICENSE#:
MAILING ADDRESS: f PHONE if:
q /6Aei,ilvivisiv' A,' 5-- c--- `051
(street) (city/state) (GIP)
PLUMBING FIXTURES
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- % X $6 -
RAY,FOOD,PREP/CULINARY EAT ! ( n
6 DISHWASHER e J - / X _ $6 - Y
7 CLOTHES WASHER ,v X $6 -
8 GARBAGE DISPOSAL / X $6 - l 41
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 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6 -
RP.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL • X $6 -
HOLDING TANK
—
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL: a-C
iOD OF PAYMENT
•'114.Sk PLUS PROCESSING FEE: ��
ISH ❑ CHECK ❑ ❑ L ..::_L..i
TOTAL PERMIT FEE DUE:
.•
EXPIRES:
CARD NUMBER:
ORIZED SIGNATURE:
3 OTY c - 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
�ne Spokane Valle.:r,WA,99206 509-688-0037-Fax
4000 yalleY. For Inspections, call 509-688-0054
-Mechanical Permit Application
PROJECT ��/ PERMIT
ADDRESS: ,2) 2:2'2- 1)a(�!i-..- USE:
OWNER: �J- _� ''�
��L Cae,l-j; 4PHONE(Daytime Contact):
MAILING ADDRESS:
132-2-z6 0 /' 14441 5 u1A
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#: <pu f j Lj e l6 -n
!
MAILING ADDRESS: PHONE A: ��c-41-7
j�, / !�/
(street) (city/state) (ZIP)
•
DESCRIPTION OF WORK t 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 $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 2001-1,750M BTU X . $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95 .-
12
12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 .
13 RANGE -
14 DRYER - X $10
• 15 FUEL BURNING WATER HEATER - X $10 -
16 MISC.FUEL BURNING APPL. - X $10 -
• 17 GAS PIPING(ea.Outlet) - r X $1 1 .
18 DUCT SYSTEMS - it. • 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 IHOOD - - X $50 =
24 TYPE 11 HOOD / X $10 . p
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 $35
29 AIR CONDITIONER +50 TON. • X $60 -
30 LPG STORAGE TANK - X $10 .
31 WOOD ORPELLET STOVE/INSERT - X $10 .
32 WOOD STOVE-FREE STANDING - X 525 .
•
•
SUBTOTAL: )-(AND
METHOD OF PAYMENT PLUS PROCESSING FEE: —33„Q—
YEA iie.-251". TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK ❑ ❑ I___..-_. ``.'_
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: