2003, 11-07 Permit App: BLD-03-03021 Residence , .
s' oI'
4000 Valley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 108
Spokane Valley, WA 99206
Phone: 509 36 Fax. 509 7
REQUIRED SITE INFORMATION
STREET ADDRESS: 30 IS )61 . diAy.../
ASSESSOR'S TAX PARCEL ��MBBER(S):
LEGAL DISCRIPTION: U't/ / ��` f '
1 1 .1:. /(2id/U
PER DESCRIPTION:
MAIN G PERMIT • Li CHANGE IN USE - 0 GRADING 0 MANUFACM RD HOME
0 RELOCATION U SIGN °TENANT {BOTHER..
1 _ OWNER / APPLICANT INFORMATION
O OWNER: 0 APPUCANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,ST ZIP CITY,STATE,ZIP
a CONTRACT*ii 1/A.40.4k...14 114 4 , a ARCHITECT:
PHON 1l. 4M1 i. lI PHONE FAX
ADDRESS: /i 4iil. C./,,, ' ADDRESS:
cif /$TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE Sit ,`6,�1 {71 CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: n D MAIN FLOOR SQ FT: /0 7 3
BUILDING HEIGHT TO PE��A((''K++: OCCUPANCY GROUP:. FLQOR FT: �A �5 t
BUILDING DIMENSIONS:` '9/I 1//I I I CONSTRUCTION TYPE: UNFIN BASEMENT: I O� S.
NUMBER OF STORIES: p STRUCTURES ON PROPERTY: I FINISHED BASEMENT:�
f
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: / 9✓
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: a,C-- CURRENT PROPERTY USE: DECK'
REAR SETBACK: ✓0 CURRENT SEPTIC USE: Vies\ PG 'U`
LEFT SETBACK: CURRENT WELL USE: N/A
____4_____.
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:3/93 _ . _
i
Sl?Okarie
.0, Valley
• PLUMBING PERMIT APPLICATION
PROJECT 1� PERMIT
ADDRESS: S 1 USE
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street (city/state) (ziP)
C• •CIOR: LICENSE#:
p12,4,.,.., ,,,_
6188+c49
C.
DRESS: ONE#: . 1 ,.; _ 4o 71
PICA ,A4. ifiler-i-nin
(street) (city/state) (zir)
• PLUM8IN0•FIXTURES •
DESCRIPTION DETAILS *OF UNITS X COST EQUALS - AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 •
2 URINALS X $6
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6
5 SINKS IAVS/BA.SINS,BAR,FLOOR. X $6
KITCHEN,LAUNDRY,UTIUTY, •
JANITOR,PHOTO,X-RAY,FOOD, /n
PREP/CUUNARY/MEAT (� •
6 DISHWASHER X • $6 =
7 CLOTHES WASHER X $6
8 GARBAGE DISPOSAL iX $6 •
9 WATER SOFTENER 1 X $6
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, f $6
CONDENSATE X =
12 FOUNTAINS,DRINKING X $6
13 WATER PIPING/DRAIN-1N INSTALLATION,ALTERATION, X $6
WASTE,VENT, REPAIR,REVERSALS
PLUMBING REVERSAL =
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, X $6
HOSE BIB,STEAMER,PROOFER,
• CARBONATOR,SWAMP COOLER 3
_
16 CROSS CONNECTION VACUUM BREAKER,CHECK • X $6
DEVICE VALVE,AND R.P.B.P.D.FOR:
VATS,SUMPS,TANKS,BOILERS =
17 SPRINKLER SYSTEM / X $25
18 INTERCEPTORS GREASE TRAP,SAND TRAP, • $6
CHEMICAL HOLDING TANK X
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC PLUMBING FIXTURE •
X $6
-
SUBTOTAL
❑ CASH ❑ COCK 0 MUM MIR ❑ y" 1 PLUS PROCESSING $35.00
FAXED PERMITS WILL MX HE ACCEPTED WITH PAYMENT FEE
OF A MAJOR CREDIT CARD
• TOTAL PERMIT FEE
•
• DUE
DATE: ..'-,. •
•
BANKCARD NUMBER -=,—�_
AUTHORIZED SIGNATURE: 1.�
Sio°� ane '
00Val ey
MECHANICAL PERMIT APPLICATION
ic? A
OWNER: t PHONE(Daytime Contact):
MAILING ADDRESS: -
oRs LE (street) (city/state) •(Zip)
.iiir E#:
W deft-A — /ND otd
MAILING ADLAR SS: PHONE it
i-/84- - / 465-
1-1-01q
Cil 7
(street) (city/state) (zip)
DESCRIPTION OF WORK #OF VIM 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) -OR400,000 X $50 =
4 UNUSTED APPLIANCE(ADDmONAL FEE) >400,000 X $100 =
5 USED APPLIANCE(WSEC min.AFUE rating) -OR<400,000 X $50 =
6 USED APPLIANCE(WSEC mh.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION 101-500M BTU X $28 =
9BOILER/REFRIGERATION 501-1,000M BTU X $39 = '
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95' mi
•
'" 12 GAS LOG;GAS INSERT,GAS FIREPLACE - •,, X , $10 =
13 RANGE
X _ $10 =
14 DRYER - X $10
15 FUEL BURNING WATER HEATER - X $10 =
16 MISCELLANEOUS FUEL BURNING APPL -
LLX $10 _
17,GAS PIPING(ea.Outlet) - `rj X $1 =
18 DUCT SYSTEMS - X $10 is
19 VENTILATING FANS 5 x $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT include ducting) >10,000CFM X $19 =
22 EVAPORATIVE COOLERS -
x $10 " _
23 TYPE I HOOD - X $50 =
24 TYPE II HOOD - 1 X $10
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 +5OTON X ' $60 =
30 LPG STORAGE TANK - • X $10 •
31 WOOD OR PELLET STOVE/INSERT - X . $10 =
32 WOOD STOVE-FREE STANDING - X $25 . =
• air; I SUBTOTAL
0CASH 0 CHECK <� .
❑ 0 �` PLUS PROCESSING
FAXED PERMITS WILL BE ACCEPTED WITH PAYMENT $35.00
OFAMAJOR C EDTTCARD FEE
TOTAL PERMIT FEE
DATE: EXPIRES: DUE
BANKCARD NUMBER: (W—' . .
AUTHORIZED SIGNATURE: '
r
A
..) 90.00
N,
Lo
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0 10 20 40 Founded 1946
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1.1.111111111.11111111111111111. " IMPSOn Engineers, Inc.
CIVIL ENGINEERS & LAND SURVEYORS
N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789
SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323