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2007, 07-31 Permit App: 07002985 Adult Family Home Permit Center S « 11703 E Sprague Ave,Suite B-3 PERMIT NUMBER: `1— c S pokane Spokane Valley,WA 99206 jValley (509)688-0036 FAX: (509)688-0037 PERMIT FEE: J a www.spokanevallev.org Community Development Residential Construction New Construction n Accessory Bldg Permit Application [-I Addition/Remodel [ I Deck Other: 4i,upj- Famsfiti9446W4____ SITE ADDRESS: - jc'7'? V 1- att ASSESSORS PARCEL NO: LEGAL DESCRIPTION: Building Owner: --1,60 Contractor: Name: Name: Address: Address: City: State: Zip: City: State: Zip: Phone: Fax: Phone: Fax: Contractor Lic No: Exp Date: Contact PersonA� City Business Lic.No: Name:¶ f, V'l[/C� Phone:! a `7 ' Describe the scope of work in detail: Cost of Project: $ Proposed Use: a...10-k— 69/11V1.4.61,_ **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: TOTAL HABITABLE SPACE: MAIN FLOOR TO SQ. 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: IMPERVIOUS SURFACE FTG: AREA: FINISHED BASEMENT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG: 30% SLOPES ON SQ. FTG: PROPERTY: # OF BEDROOMS: CONSTRUCTION TYPE: HEAT SOURCE: SEWER OR SEPTIC? 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.6) Plans or additional information may be required to be submitted, and subsequently approved before this application can begrocesseFl. SIGNATURE -) DATE: 7-3/ 0 7 Method of Payment: 0 Cash n-Check 0 Mastercard 0 VISA Bankcard#: Expires: VIN#: Authorized Signature: REVISED 2115/07 S pokane .0•*Valley 11703 E Sprague Ave Suite B-3 ♦ Spokane Valley WA 99206 509.688.0036 ♦ Fax: 509.688.0037 ♦ cityhall@spokanevalley.org Residential Plan Submittal Minimums ❑ Completed Building & Mechanical application with: Accurate address, Parcel Number and/or Legal Description, description of work, owner and contractor information, signature, and date. ❑ Two sets of plans including Site Plan, elevations, floor plans, foundation plans With details, roof plan, framing plans & details. ❑ Show the height of any proposed buildings or accessory structures. ❑ Floor plan for each floor: Dimension to scale (minimum 1/8") and label each Room (including sq. footage of house and garage on plans) Show each level of existing house and square footage of any additions. ❑ All braced wall panel types: show locations and details of installation, including engineered design. ❑ Egress windows: Provide at least one window or exterior door approved for Emergency escape or rescue from a basement and in every room for sleeping. ❑ Smoke detector locations. ❑ 22" X 30" attic access location ❑ 18" X 24" crawl space access: ❑ One-hour separation detail: between house and garage ❑ Floor framing details: Joist type, size, spacing and installation details ❑ Roof framing plan and details ❑ Furnace and hot water heater location. ❑ All header locations: type, size, and connections ❑ Foundation plan ❑ Insulation information APPLICATION AND INSPECTION CHECKLIST - Adult Family Home Code References: 2003 IBC 310(WAC 51-50)and 2003 IRC 110(WAC 51-51) APPLICATION NUMBER: Applicant must complete sections 1, 2, 3, and 4. Application must be complete to be processed. SECTION 1- PROPERTY INFORMATION SITE ADDRESS: I 9, �(I 2 Com/ V C ( E ASSESSOR'S TAX/PARCEL#: - • SECTION 2-APPLICANT INFORMATION PROPERTY OWNER NAME: (.> '� `� L 4'�C/�� DAYTIME PHONE: LICENSEE NAME(IF DIFFERENT):(- (/ 9 ,�S A DAYTIME PHONE: ' I / - 57 SECTION 3—FLOOR PLAN A complete floor plan must include all sleeping rooms, identified by number(#1, #2, #3 etc.)and all components for exiting, i.e. stairs, ramps, platform lifts and elevators. (Attach additional sheets if necessary) SECTION 4—DISCLAIMER/SIGNATURE BLOCK I certify under penalty of perjury that the information furnished by me is true and correct to the best of my knowledge,and that I am requesting or I am authorized by the owner of the above premises to request inspection for the operation of an Adult Family Home at this location. I further certify that I am in the process of making an application to the Department of Social and Health Services for an adult family home license and that I have also made application to the applicable jurisdiction for the appropriate license(s)to conduct such business at this location. I further agree to hold harmless the jurisdiction conducting such inspections,at my request,as to any claim(including costs,expenses,and attorneys'fees incurred in the investigation of such daim),which may be made by any person,induding the undersigned,and filed against the jurisdiction,but only where such claim arises out of the reliance of the jurisdiction,including its officers and employees,upon the accuracy of the information supplied to the jurisdiction as a part of this ap lication. NAME/TITLE: �' I; �C DATE: 5/.- Cy 7 0 PROPERTY OWNER APPLICANT 0 LICENSEE SECTION 5 - INSPECTION CHECKLIST Note: Checklist to be completed by building department in the jurisdiction home will be located. YES NO Home licensed (or applying for license)on or after July 1, 2001 ❑ ❑ SLEEPING ROOMS ❑ ❑ Sleeping Room #1 ❑ S 0 NS1 0 NS2 Bedroom door is openable from the outside when locked 0 0 Closet doors are readily openable from the inside ❑ 0 Smoke alarm is installed in the bedroom 0 ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" 0 ❑ Sleeping Room #2 ❑ S ❑ NS1 ❑ NS2 Bedroom door is openable from the outside when locked 0 0 • Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ 0 Sleeping room window has a maximum sill height of 44" 0 ❑ Sleeping Room #3 ❑ S ❑ NS1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" 0 ❑ Sleeping Room #4 ❑ S ❑ NS1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ 0 Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ Sleeping Room #5 ❑ S ❑ NS1 ❑ NS2 Bedroom door is openable from the outside when locked ❑ 0 Closet doors are readily openable from the inside ❑ 0 Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) ❑ ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ Sleeping Room #6 ❑ S ❑ NS1 ❑ NS2 Bedroom door is openable from the outside when locked 0 ❑ Closet doors are readily openable from the inside ❑ ❑ Smoke alarm is installed in the bedroom ❑ ❑ Sleeping room window has a minimum net openable area of 5.7 sf. (minimum dimensions-24"high;20"wide) 0 ❑ Sleeping room window has a maximum sill height of 44" ❑ ❑ GENERAL Bathroom doors are openable from the outside when locked ❑ ❑ Smoke alarms are installed on all levels of the dwelling ❑ ❑ All smoke alarms are audible in all parts of the dwelling upon activation of a single device ❑ ❑ Access road and water supply approved by Fire Department ❑ ❑ ❑ PASSED ❑ CORRECTIONS REQUIRED ❑ PERMIT REQUIRED INSPECTOR: DATE: Application and Inspection Checklist developed by Washington Association of Building Officials(WABO),in cooperation with Department of Social and Health Services(DSHS)for use by both departments and licensors. FIRE EVACUATION PLAN ac-\4\i,c1((ik , \Goz,\.',(76(A Living Roam a %. ____---c—Y ji— Li uBedrooma Wen 11 --", ---J1 Dinning Room 4.1 _ ��1 i ?C % �f i . living Ra o#2 - X11 __,7c,,i,, fI(\ tlMff`e ! Bedroom\ 31-1 I '' ‘.' . i'''-':-'''':14'''' ' r0.( l ' Bedroom 76 Bedroom , / '- i 4.,.4r____jz.12k (Ck-lc--- I inc esa of a fire or any other disaster that causes ___________--- evacuation out of the home. EXIT out the front door or escape window. EXIT in a safe and calm manner. Everyone is to walk out to the end of the driveway and wait for staff's further instructions. ( 1 :re, detoCS tot 66 6/0 Sc6 \-44- t 0 s,` iscp_ pgfivtnri v tn;o "r • 1 1 \ , Living Room #2 i Downstairs 1 { ,j 0 i' �;�, X; w ,tee I 1 __----- ice \I 1storage Hallway \ _ -.r 111101.I min 1111111 I 6E3! Ptr , de. .e_c ©c ,,,, t 1 r ex*E, i, i, p , 0 uu,Gh e r - ‘ V other disaster that causes evacuation of the it.,im exit cut-rile 3'3Ysa in case a fire or any s. t to 1::..!Iiik cum'253 :c .afs;l :.tt. door or escape window Exit in a safe and calm manner. and wait for staff. I U.,a