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2004, 08-23 Permit App: BLD-04-07417 Residence BUILDING PERMIT APPLICATION WORKSHEET Spoan'lane City of Spokane Valley Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 .0,•••IrValle Spokane Valley, WA 99206 Phone; (509) 688-0036•Fax: (509) 688-0037 REQUIRED SITE INFORMATION Street Address: 3 1)on 5 t. v Assessor's Tax Parcel Number(s): Legal Description: LO 7- S S �K Z -pJ b (illi PE,M1T DESCRIPTION: 7 air? C2—, Ilre Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION 0 Owner: 0 Applicant: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State Zip Code 1121 Contractor: C,USe4hrn riz, ('UNSI 0 Architect: Phone:9c31-77 33 Fax: X'-a') 7/ Phone: Fax: Address: 165-7.t t. 5Ft.,;ei, Address: UYC 9463 City State Zip Code City State Zip Code WA State Contractor License #: 61,1#3C/6L/2fContact: 6/1 -171-'7733 PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: zi DIMENSIONS: a )C UI 7— g #OF STORIES: z MAIN FLOOR TO SQ. F`TG:Z 1 2""FLOOR SQ. FIG. UNFIN SE[ ? jMENT SQ. FTG: I L' FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: LI � DECK/COV. P�,A I SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURS js #OF BEDROOMS: 0 q TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30%SLOPES ON PROW: SEWER OR ON-SITE SEPTIC SYSTEM? 5e,(,,,) • 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: DatelTime: 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 D 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: ` MECHANICAL PERMIT APPLICATION Sartaka• e\..k City of Spokane Valley Community Development Department Valley BuildingDivision 40,0001:1° y 11707 E. Sprague Avenue, Suite 106 Spokane Valley, WA 99206 Phone: (509)688-0036;Fax: (509) 688-0037 FOR INSPECTIONS, CALL(509)688-0054 Project Address: Permit Use: Owner: Phone(Daytime Contact): Mailing Address: City State Zip Code Contractor: e 1Lik ryvfc., ct-1 w G License#: Phone#: Mailing Address: City State Zip Code T #OF T TOTAL DESCRIPTION OF WORK UNITS X COST = AMOUNT 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 1 X $15.00 = 2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 = 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 $100.00 = USED APPLIANCE(WSEC min.AFUE 5 rating) Equal to or fess than 400,000 X $50.00 = USED APPLIANCE(WSEC min.AFUE 6 rating) More than 400,000 X $100.00 = 7 BOILER/REFRIGERATION 1-100M BTU X $15.00 = 8 BOILER/REFRIGERATION 101-500M BTU X $28.00 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 = 10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 = 11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 = 12 GAS LOG,GAS INSERT,GAS FIREPLACE 1 ,X $10.00 = 13 RANGE X $10.00 = 14 DRYER X $10.00 = 15 FUEL BURNING WATER HEATER i X $10.00 = 16 MISC.FUEL BURNING APPLIANCE X $10.00 = 17 GAS PIPING(each outlet) 3 X $1.00 = 18 DUCT SYSTEMS X $10.00 = 19 VENTILATING FANS L') X $10.00 = 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 $19.00 = 22 EVAPORATIVE COOLERS X $10.00 = 23 TYPE l HOODX $50.00 = . 24 TYPE II HOOD ' X $10.00 = 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X ' $12.00 = 26 AIR CONDITIONER 3-15 TON 1 X . $20.00 = 27 AIR CONDITIONER 15-36 TON X $25.00 = 28 AIR CONDITIONER 30-50 TON X $35.00 = 29 ` AIR CONDITIONER More than 50 TON X $60.00 = 30 LPG STORAGE TANK X $10.00 = 31 WOOD OR PELLET STOVE/INSERT X $10.00 = 32 WOOD STOVE-FREE STANDING 7 $25.00 = METHOD OF PAYMENT: _ SUBTOTAL Q CASH CICHECK 0 VISA Q MC DATE: PROCESSING FEE $35.00 CARD#: EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: PLUMBING PERMIT APPLICATION Y Clan © City of Spokane Valley Community Development Department �r BuildingDivision Valley 1 1707 E. Sprague Avenue, Suite 106 400, Spokane Valley, WA 99206 Phone: (509)688-0036;Fax: (509)688-0037 FOR INSPECTIONS, CALL(509)688-0054 Project Address: Permit Use: Owner: . Phone (Daytime Contact): Mailing Address: City State Zip Code Contractor: Z\m 'i S Q L riki,)n)(, License#: Phone#: Mailing Address: • City State Zip Code #OF TOTAL DESCRIPTION OF WORK UNITS X COST - AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6.00 = 2 URINALS X $8.00 = 3 TUBS X $6.00 = 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT i X $6.00 = 5 SINKS LAVS/BASINS,BAR,FLOOR, KITCHEN,LAUNDRY,UTILITY, c X $6.00 = JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT 6 DISHWASHER l X $6.00 = 7 CLOTHES WASHER 1 X $6.00 8 GARBAGE DISPOSAL I X $6.00 = 9 WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 = CONDENSATE 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 = VENT, PLUMBING,REVERSAL REPAIR,REVERSALS 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 = 16 WATER USING DEVICE ICE AN/OR COFFEE MAKER, HOSE BIB,STEAMER,PROOFER, X $6.00 = CARBONATOR,SWAMP COOLER 17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR: X $6.00 = VATS,TANKS,BOILERS 18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 = CHEMICAL HOLDING TANK 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 = METHOD OF PAYMENT: SUBTOTAL CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00 DATE: EXPIRES: TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: / /7 v 7 v --- P/// ' 1-1-1 -'-- / Thr site isn9 submitted for the Purpose of G obtainingSatboitaing permit and is a nue and correct -' / representation of the ,. Alf known property ��/ / dimensions. "". and oMmer is .,. lines! ;�,' / / .,..,/ • ,' '' / have been critical�� - :�' /- rem / - , „R d IP ' ` / / 4 4, q‘--)•,.. / l c•/_6Y _J3 / � }4 Utilityl� ', / Easemen ,4 T2s �� rCA / / S0��. 00' p —(� AoonEss i 3 J. t � /41.11-,-,J 0 `�Zzg- ZONE 1`c , - 2 SOADMOTH A . FRONT COMMENTS REViEWEDIN•NE A/,A1. 4 .; oNo � 39D3 S , o f�e.L 4:7) PINE ROCK RIDGE 1ST ADDITION LOT 3 BLOCK 2 0 10 20 40 Founded 1946 �� �" umpson Engineers, Inc. CIVIL ENGINEERS & LAND SURVEYORS N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789 SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323