2005, 02-04 Permit App: 05000290 RemodelSpokane
Val Iey
! O517 s )s -2e
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: S)0, 0 �- //)11//7
y
Assessor's Tax Parcel Number(s):
Legal Description:
(0
-7 PERMIT DESCRIPTION: ' �(c�-�G/D�S�I ) (O
R Building Permit
II
Relocation
Q�j-1)0!
/r%z° i✓17�rrr�a �- r(.714 c\41
n Change in Use n Grading
n Tenant Improvement n Fire Safety ❑ Other
n Manufactured Home
OWNER/APPLICANT INFORMATION
Owner: d 6("rs 77- 1/� rS
422- s` 7 y Phonc: 09 Fax:
Address: ioa' o G (///?-7
/4 c- /9 ,rs/zz) 151
City
Contractor:
Phone:
State Zip Code
Address:
Fax:
City
State Zip Code
WA State Contractor License #:
Applicant: .- G1' m rf-
Phone:
Address:
Fax:
City
Architect:
Phone:
State Zip Code
Address:
Fax:
city
Contact:
State Zip Code
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK:
DIMENSIONS:
# OF STORIES:
MAIN FLOOR TO SQ. FTG:
2M17u FLOOR SQ. FTG:
UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG:
GARAGE SQ. FTG: .
DECK/COV. PATIO SQ. FTG.
OCCUPANCY GROUP:
CONSTRUCTION TYPE:
HEAT SOURCE:
# OF BEDROOMS:
TOTAL HABITABLE SPACE:
IMPERVIOUS SURFACE AREA:
COST OF PROJECT: �,D30%
'li //2,-,r,74'g000.-4' /f0,-- .S q 70
SLOPES ON PROPERTY:
SEWE OR ON-SITE SEPTIC
EM7
MANUFACTURED HOME
Width:
Manufacturer:
Length: Year: Pit Set:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler:
Tent:
Valuation:
# of Heads: Fire Alarm:
Fireworks Display: Blasting:
Above/Underground Storage Tank Size:
Paint Booth:
Date/Time:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner:
Address:
Inspector:
Address:
Phone:
Fax:
cny
Phone:
State
Fax:
Zip
City
Stale Zip
SPECIAL INSPECTIONS
(I
BOLTING ❑ CONCRETE ❑ REINFORCEMENT
Firm Name: Phone:
Inspector(s):
Fax:
WELDING
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 E Other
Bankcard #: Expires: VIN#:
kuthorized Signature:
r J
PLUMBING PERMIT APPLICATION
'Valk)/ ePhone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Project Address:f/oeVo 7:417-7 En, 7
Owner /ZoAr'✓` 7 / ' StaAr-s
Mailing Address:9//ide x oral' c x-10 3 -SdiZsem c
ity
Contractor License #:
Mailing Address:
Permit Use:
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone (Daytime Contact):
9%?-ecZ
12-711
State
Zip Code
Phone #:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
K OF UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
1
X
56.00
=
2
URINALS
X
E6.00
=
3
TUBS
X
56.00
4
SHOWERS (PER TRAP)
BATH, STALL, ONSITE BUILT
1
X
56.00
=
5
SINKS
LAVS/BASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY. JANITOR, PHOTO,
X-RAY, FOOD. PREP/CULINARY MEAT
t
X
56.00
=
6
DISHWASHER
X
56.00
=
7
CLOTHES WASHER
X
56. D0
=
8
GARBAGE DISPOSAL
X
56 00
=
9
WATER SOFTENER
X
56.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
56.00
=
11
FLOOR DRAINS
AREA, CASE, COIL, TRENCH. CONDENSATE
X
56 00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
56.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT, PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
56.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
X
56.00
=
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB.
STEAMER
PROOFER. CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
AND R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
56,00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
56.00
=
19
MEDICAL GAS (per outlet)
NITROUS, OXYGEN
X
56.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
56.00
=
21
PRNATE SEWAGE DISPOSAUSYS
X
520.00
=
22
INDUSTRIAL WASTE
INTERCEPTOR
X
515.00
=
METHOD OF PAYMENT:
❑ CASH ❑ CHECK
DATE:
SUBTOTAL
0 VISA 0 MASTERCARD
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: