2005, 07-14 Permit App: 05002389 Duplex project Number: 05002389 Inv: 1 Application Date: 07/14/2005 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW DUPLEX W/ATTACHED GARAGES- Contact: NORTHWEST HOMES
NATURAL GAS Address: PO BOX 72
C-S-Z: GREENACRES,WA 99016
Setbacks: Front 100 Left: 5 • Right: 5 Rear: 30 Phone: (509)924-1491
Group Name:
Site Information: Project Name: ROW
Plat Key: Name: SP-1251A-00 District: Nort
Parcel Number: 45143.1576 Block: Lot: E
SiteAddress: 14021 E VALLEYWAY AVE Owner:Name: KLEIN,JERRY&LINDA
Address: 721 N PINES RD
Location::CSV SPOKANE VALLEY,WA 99206-
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: ❑
Area: 24,749 Sq Ft Width: 100 Depth: 246 Right Of Way(ft): 0
Nbr of Bldgs: 1 Nbr of Dwellings: 2
Review Information:
Review
Site Plan Review Released By: ` y�
41'/'
nn 1
1C1�
Plan Review
Released By:
Approach/Drainage Released By: -4C)
Sewer Review {
Released B .�''�,�'„� , ,®
CC) I /or
Permits:
Operator: K_C Printed By: K_C Print Date: 07/14/2005
Project Number: 05002389 Inv: 1 Application Date: 07/14/2005 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Approach
Contractor: UNKNOWN Firm: UNKNOWN
Address: UNKNOWN Phone: (000)000-0000
UNKNOWN,WA UNKNOWN
Item Description Units Unit Desc Fee Amount
APPROACH INSPECTION 1 NUMBER OF $25.00
CONST IN ROW-APPROACH 1 NUMBER OF $25.00
Permit Total Fees: $50.00
Building Permit
Contractor: NORTHWEST HOMES& Finn: NORTHWEST HOMES&REMOD
Address: PO BOX 72 Phone: (509)924-1491
GREENACRES,WA 99016
Building Characteristics
Group: R-3 Type: VB
Total Area 3572
Building Height 18
Stories 2
Dwelling Units 2
This Application: Total Project:
Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation
2ND FLOOR R-3 VB 650 $48,542.00 650 $48,542.00
CARPORT U-1 VB 128 $1,920.00 128 $1,920.00
GARAGE U-1 VB 1,200 $22,800.00 1,200 $22,800.00
RESIDENCE R-3 VB 2,922 $218,214.96 2,922 $218,214.96
Totals: 4,900 $291,476.96 4,900 $291,476.96
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $2,068.95
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $827.58
Permit Total Fees: $2,901.03
Operator: K_C Printed By: K_C Print Date: 07/14/2005
Project Number: 05002389 Inv: 1 Application Date: 07/14/2005 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Mechanical Permit
Contractor: NORTHWEST HOMES& Firm: NORTHWEST HOMES&REMOD
Address: PO BOX 72 Phone: (509)924-1491
GREENACRES,WA 99016
Item Description Units Unit Desc Fee Amount
GAS WATER HEATER 2 NUMBER OF $20.00
GAS APPLIANCE<=100,000BTU 2 NUMBER OF $24.00
GAS PIPING 4 #OF UNITS $4.00
VENTILATING FANS 4 NUMBER OF $40.00
HOOD-TYPE II 2 NUMBER OF $20.00
Permit Total Fees: $108.00
Plumbing Permit
Contractor: NORTHWEST HOMES& Firm: NORTHWEST HOMES&REMOD
Address: PO BOX 72 Phone: (509)924-1491
GREENACRES,WA 99016
Item Description Units Unit Desc Fee Amount
TOILETSBIDETS 4 NUMBER OF $24.00
SINKS 6 NUMBER OF $36.00
SHOWERS 2 NUMBER OF $12.00
TUBS 2 NUMBER OF $12.00
DISH WASHERS 2 NUMBER OF $12.00
CLOTHES WASHER 2 NUMBER OF $12.00
WATER PIPING-DWV 2 NUMBER OF $12.00
Permit Total Fees: $120.00
Notes:
Payment Summary:
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Approach $50.00 $50.00 $0.00 $50.00
Building Permit $2,901.03 $2,901.03 $0.00 $2,901.03
Mechanical Permit $108.00 $108.00 $0.00 $108.00
Plumbing Permit $120.00 $120.00 $0.00 $120.00
$3,179.03 $3,179.03 $0.00 $3,179.03
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of
the provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 07/14/2005
BUILDING PERMIT APPLICATION WORKSHEET
` Slicokdine City of Spokane Valley Community Development Department
Building Division
• E. Sprague Suite 106
11707 Avenue,
alleY 410000VSpokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /�Li Z ( V.(4/1,7 -69 U1/436. ._
Assessor's Tax Parcel Number(s): � / � 7
,'� , 1
k.,--
Legal Description: --r 44e C--
PERMIT
PERMIT DESCRIPTION: 01,,,t.:1--, 4m,%7 (--c,,,...„,.._
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
N OWNER/APPLICANT INFORMATION
•
❑ Owner: �,m2ki% '. ❑ Applicant: •
Phone: 6tzz �c�
Fax: Phone: Fax:
Address: -7Z.( N• rIN&S 2ci, Address:
Soca La.t L C.1 LA-,i^4elf°i La 4,
Cit State Zip Code City State Zip Code
❑ Contractor: `i f..c_l. 4 ..,o re-1 ❑ Architect:
Phone: 12_4 - 144.ii Fax: Phone: Fax:
Address po, au 1,2. Address:
ev n 4 s xs be eLs s 4t_wa g°i o r r
City Stag, - .. Zip Code City State Zip Code
• WA State Contractor License#:I/Of'TNA/R 9 7//,'\;_ Contact: /�u c,�, t412./vo(.r
Spokane Valley Bus. Liscense#: Contact:
M PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
• r$ ' 9ox�� Fy5� � - 4� 2
MAIN��// FLOOR TO SQ. FTG:t� /� 2""FLOOR_SQ. /0:.)--C) UNFIN BASEMENT SQ. FTG:
/414/ SC� IJ�c. r- .42Z . 0 S-- E 2-JI Ltn1 ( C
FINISHED BASEMENT S2. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTI TYPE HEAT SOURCE:
e- 64C r ,�s
#OF BEDROOMS: TOTAL HABITABLE sPE IMPERVIOUS SURFACE AREA:
s, 72 2.'i e 6-7 S i=
COST OF PROJECT: 30%SLOPES ON PROPERTY: j , SEWER OR ON-SITE SEPTIC
f 9' x'79 /6 SYSTEM? 5 ,�1 'f,
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON 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 ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
` tne PLUMBING PERMIT APPLICATION Community Development Department
uru� Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E, Sprague Avenue, Suite 106
Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: /4 7 2 / //�, ,. S�� � Permit Use: Ii)�L-Ti - Xarr;,L.7
w
Owner: : al ii GI' Phone (Daytime Contact): e,2.2, -7./.5-_,c__).
Mailing Address: 7.2 / t/. �1;, S gc( R. ,} V L 1 r w6_ i l2 a(0
ICity State Zip Code
Contractor. v 4 gJ eW • License#:WpK i-n-/ - j kw), Phone#: aj24-i'-
Mailing Address: RN f )( 72. � -�&--A man p S t.L.:.A-. `t'1 n i(r,
City State Zip Code
DESCRIPTION OF WORK _ *OF UNITS X .COST- TOTAL AMOUNT
1 TOILETS WATER CLOSET.BIDETS' 1 X '$6.00• = ZT 4110 •
2 URINALS X $6.00 =
3 TUBS • '— •
2 X $6.00 _ . /2.ei C''
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT ' . 1 X $6.00 = 2#e:n C5
• . LAVS/BASINS,BAR.FLOOR,KITCHEN,
5 SINKS LAUNDRY.UTILITY,JANITOR,PHOTO, X $6.00 = '
X-RAY,FOOD,PREP/CULINARY MEAT (.* Z 82j
6 DISHWASHER 2 X $6.00 = 12. elp
7 CLOTHES WASHER 2, X $6.00 =• /2. ETC,
8 GARBAGE DISPOSAL " " . 2, x $6.00 = I2 r C+Z:+
9 WATER SOFTENER X , . $6.00 = J
10 ELECTRIC HOT WATER TANK • NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE•COIL,TRENCH,CONDENSATE X $6.00 =
'ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
•
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, .
14 VENT,PLUMBING,REVERSAL "REVERSALS X $6.00 = •
- 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = 1
ICE AN/OR COFFEE MAKER,HOSE BIB, •
16 WATER USING DEVICE STEAMER X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
- VACUUM BREAKER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.O.FOR: VATS,TANKS,BOILERS X $6.00 =
GREASE TRAP,SAND TRAP, •
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS.OXYGEN X $6.00 - = _
MISCELLANEOUS PLUMBING
20 FIXTURE • . X $6.00 = • •
21 PRIVATE SEWAGE DISPOSAUSYS • . X $20.00 - _
INDUSTRIAL WASTE
22 INTERCEPTOR X - $15.00 = _
SUBTOTAL
METHOD OF PAYMENT: •
0 CASH iCHECK ❑ VISA ❑ MASTERCARO PROCESSING FEE .$35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: 1.c6".62,
•
BANKCARD NUMBER: .
AUTHORIZED sIGNA U / / _
MECHANICAL PERMIT APPLICATION Community Development Departmen
�" an - Building Divisioi
ILL,, Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 10(
1C}' For Inspections, Call (509) 688-0054 Spokane Valley, WA 9920(
Project Address: 1 ,-110 2..I ✓A/ I%-,/,,t)et vi ...o VA VA �t�A.,Permit Use: mI,. t i, .IrwY.,iIu D j /r,y(
Owner: V"�fa.E. K t zter..t , / ` Phone (Daytime Contact): et?2 - 1► no�T^
Mailing Address: ' ?a/ !`.1, ,,,,r i=s r�J . S t ,71.4`..L
L �,t _ Lb.- _+`i el 2c,to
City J State Zip Code
Contractor: -1-2.o t4erovt.._ License#:N012 i H/124)7!Ir i 3 Phone#: 9Z 4- 1 4--1 el i
Mailing Address: MB T%D6 RA, 7 z Gaas°s, . let, InX s wr499a I
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 2, X $t2.D0 = Eq. c r✓'
• 2 , FUEL BURNING APPLIANCE More than 100,000 X a $15.00 =
3 UNLISTED APPLIANCE(Additional Fee) • Equal to or less than 400,000 X $50.00 =
•
4 UNLISTED APPLIANCE(Additional Fee) ' More than 400,000 , X 5100.00 =
5 USED APPLIANCE(WSEC min.AFUE rating) Equal toor less than 400,000X. $50.00 = -
- 6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 =
• 7 BOILER/REFRIGERATION 1.-100M BTU X $12.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $20.00 = •
9 BOILER/REFRIGERATION 501-1,00DM BTU • X $25.00 =
10 BOILER/REFRIGERATION 1,001 -1,750M BTU X $35.00 =• •
11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X • $10.00. =
13 RANGE •X $10.00 =
14 DRYER X $10.00 = •
15 FUEL BURNING WATER HEATER 2, X $10.00 = • Z.0
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) • /f X $1.00 = 4
18 DUCT SYSTEMS L X $10.00 = 2.G
19 VENTILATING FANS Y X $10.00 = 4c
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM .• X $12.00 = ,
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
s,t 23 TYPE I HOOD • • _ X _ $50.00 = . . )1)e,4 TYPE ROOD
`-- .2 X 510.00. = Z Z7
25 HEAT PUMP/AIR CONDITIONER • 0-3 TON •
X 512.00 • =
•
26 .AIR CONDITIONER. 3-15 TON X $20.00 =
27 AIR CONDITIONER15-30 TON X $25.00 • =
. • 28 AIR CONDITIONER 30-50 TON X $35.00 ' _
•
29 AIR CONDITIONERMore than 50 TON X $60.00 =
30 LPG STORAGE TANK X - $1A.00 =
31 WOOD 0R PELLET STOVE/INSERT •• X $10.00 =
32 ,WOOD STOVE-FREE STANDING X $25.00 =
33 REPAIR&ADDITIONS X $15.00 =
34 VENTILATION SYSTEMSX •' $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 _
36 INCINERATOR-RESIDENCE i X $19.00 =
. 37 INCINERATOR-COMMERCIAL X $22.00
METHOD OF PAYMENT: SUBTOTAL
• • 0 CASH 0 CHECK 0 VISA CI MC DATE: PROCESSING FEE $35.00
CARD it: EXPIRES: TOTAL PERMIT FEE DUE: /6'3
AUTHORIZED SIGNATURE:
S P O K A N E �, C O U N T Y
UTILITIES DIVISION A DIVISION OF THE PUBLIC WORKS DEPARTMENT
N.Bruce Rawls,P.E.,Utilities Director
SPECIAL CONNECTION CHARGE (SCC)
PAYMENT OPTION SELECTION RECORD
Form must be filled out accurately,and in its entirety.and signed or a permit will not be issued.
DATE: - 7/2S/OS -Dtrtf LEX
SITE ADDRESS: 14.02.1 e.. Va.L Ywa.Y PARCEL#: 4.514;3 . 1562
OWNER NAME: SeI. /Linela 141 %en
OWNER ADDRESS: "1 Z.I N. t n_fgS 1E.A. S.17014a r WA 4 4 z.O
PAYMENT OPTION SELECTED (check one):
1. ( ) SCC and General Facilities Charge(GFC),( ), paid at issuance of Sewer Connection Permit.
Total of SCC&GFC
Received BY: Amount Paid Receipt# Check#
2. ( ) SCC ( )paid at issuance of permit.The General Facilities Charge(GFC)( )to be
paid in twenty four equal monthly payments,with no interest,upon establishm • • er I mg ' •
Received By: Amount Paid: 'eceipt# Check#
��io.j° 2 x$31. 45 , C�f G �%cc`wncc of 1 12,1c9.�'
2 x S �, e� qo Paid o '�/25/oSo ,
Ito bepaid a1 4•• ' :'nth(includes interest)over a twclty(20)year
3. (k) SCC and GF�(I 0�,3Z0 ) per
Total o SCC&GFC
period upon establishment of Sewer Billing Account
I understand that the above figures are based on the current use of the property a • that if the use of the property changes
in the future additi.nal Sewer Co • = on Fees may • required.
Ted Arnold
) • 445-57Zo i
Signature of ' operty Owner • ' operty 01"TrAM110 Date
15
i1
Signature •' tilities Staff to ///
Located at 1026 W.Broadway,4th Floor
Mailing Address: PWK-4 • 1116 W.Broadway • Spokane,WA 99260-0430
(509)477-3604 • FAX: (509)477-4715 • TDD:(509)477-7133
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d an �sAH known Prop ` I
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1. fi St,is site Paapuilding Perm °sal. d easements !
144
�t,t,,ining of the Prop structures an wetlands
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s�ntation curb lines. are areasred"� Also indicat critical�` d+mensions.11n dentified• •a othe ��/11 \have b enw „..a••".., v tt , ��bodes / i/ wt /' ` �:14 N 141s ,ned: h\14 lt y, r .' tn ypate: 1 '� 1
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COMMENTS
REVIEWED SV
This site plan is being submitted for the purpose of
obtainin8 a builtlin8 permit an is a true and correct
representation of the proposal. All known property
lines/ d(mensions, curb lines, structures and easements
have been identified. Also
bodies of water indicatetl a wetlands,
slopes or t r (tical areas.
ned:
Date:
a
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