2004, 03-31 Permit App: BLD-04-03950 Residence *lane
do,Valley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax* 509 37
REQUIRED SITE INFORMATION •
STREET ADDRESS: 3 70 A ` VIA Tit ,./ -1. _
ASSESSOR'S TAX PARCEL NUMB R(S):
LEGAL OISCRIPTION: —6-4---- 1 (A,ef At---(42--- i .."6:411.../1,'
V
PER DESCRIPTION:
UILDING PERMIT E1 CHANGE IN USE - 0 GRADING 0 MANUFACTURED HOME
0 RELOCATION aSIGN QTENANT QOTHER
OWNER / APPLICANT INFORMATION
Ci OWNER: a APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
f CITY,ST ZIP CITY,STATE,ZIP
a CONTRACT• 1 11./L/►_41 I.4 I , a ARCHITECT.:
IM
i
PHON 0111.1 � �>�. i. ,1J PHONE: FAX:
ADDRESS: /1 4i illi 1i./lig
I ADDRESS:
2CC_ /,.$TOATE,ZIP CITY,STATE.ZIP
WA ST CONTRACTOR LICENSE* C�/�; j,�,�`i�Txtip CONTACT:
•
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: f V 0 MAIN FLOOR SQ FT: q' 5�
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2ND FLOOR SQ FT: —/ 7
rr,, 140
//��'//__II
BUILDING DIMENSIONS:(O2.X'IV(o CONSTRUCTION TYPE: UNFIN BASEMENT: 73
• NUMBER OF STORIES: STRUCTURES ON PROPERTY: . N pr FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: A 0 . GARAGE: v
FLANKING SETBACK: CURRENT PROPERTY SIZE: 1 ' e COVERED DECK: - —
FRONT SETBACK: CURRENT PROPERTY USE: V PC)ptJ T DECK:
REAR SETBACK: CURRENT SEPTIC USE: 13C11
LEFT SETBACK: CURRENT WELL USE:
-RIGHT SETBACK: IMPERVIOUS SURFACE AREA: ---—
*mum .
MECHANICAL PERMIT APPLICATION
ADD mss: 3--10 S. V l JAG I i USE:S
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
- "' f (street) (city/state) -(zip)
1°� f j wElt:
}-1-Ef etA — JDZD 15w
MAILING ADd PHONE 8:
�8� - j405-"" .
EoIg 6), -
9,,D7
• (street) (city/state) (zip)
DESCRIPTION OF WORK s OI UNITY X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100.000 1 X $15 -
2 FUEL BURNING APPLIANCE - -->40C,000 ------. X - $19• . _ - _ . _
3 UNLISTED APPLIANCE(ADDf11ONAL FEE) =OR400.000 X $50 ' al
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 a
5 USED EC min.AFUE rating) =OR<400,000 X . $50 =
6 USED APPLIANCE(WSEC aim AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X - $15' _
8 BOILER/REFRIGERATION • 101.500M BTU X $28 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 =
10 BOILER/REFRIGERATION 1001-1,750M BTU X $57 =
11 BOILER/REFRIGERATION +1750M BTU X $95 =
' 12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 =
13I1ANGE - �— X $10 =
14 DRYER - X $10 13
15 FUEL BURNING WATER HEATER - S X $10 a
16 MISCELLANEOUS FUEL BURNING APPL • - X $10 I.
• 17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - c - X $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X 412 li
21 AIR HANDLER(DOES NOT include ducting) >10,000CFM X $19 =
22 EVAPORATIVE COOLERS - X 410 = •
23 TYPE I HOOD - X $50 =
24 TYPE U HOOD - / X $10 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON / X .$12 =
26 MR CONDITIONER 3-15 TON X $20 =
27 MR CONDITIONER 15-30 TON X $25 a
28 MR 3050 TON X $35 =
29 AIR CONDITIONER +50TON X $60 =
30 LPG STORAGE TANK - • X $10 _ • ,
31 WOOD OR PELLET STOVE/INSERT - X , $10 =
32 WOOD STOVE-FREE STANDING - X $25f - _
J.- — —
>--
t l SUBTOTAL
0 CASH 0 CHECK 0 ilIMMI 0 PLUS PROCESSING
FAXED PER 1.ONLYBE ACCEPTED VITHPAn wr FEE $35.00
OF A n6AJOR CREDIT CARD .
TOTAL PERMIT FEE
• DUE
DATE: • EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE 94)-- _
--- —
my I • ,
Sri6
,,.*Valley
• PLUMBING PERMIT APPLICATION
PROJECT .2 ` ,' ��� n)I 'PERMIT
ADDRESS: 0v 1USE
OWNER: PHONE(Daytime Contact):
MAIUNG ADDRESS:
(street) (city/state) (ziP)
C•.,i;- CZOR: _ ,/� •
LICENSE#: 638
4ADDRESS: (
„f. 4z, 71
i 7b/,' 4: plet.4-ylvt. Wa/-‘0
(street) (city/state) (ziP)
PLUMING'FIXTURES
i DESCRIPTION _ DETAILS *OF WI X COST
W EQUALS _ AMOUNT
1 TOILETS
WATER CLOSET,BIDETS --j X c6
•
-
2 URX 'i6 =INALS X $6
3 TUBS =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6
5 SINKS LAYS/BASINS,BAR.FLOOR, X $6
KITCHEN.LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD, /
PREP/CUUNARY/MEAT l/I/n =
6 DISHWASHER / X $6 =
7 CLOTHES WASHER X $6 =X $6
8 GARBAGE DISPOSAL c
9 WATER SOFTENER x $6 _
$6 =
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X , $6
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, /
CONDENSATE _ X
12 FOUNTAINS,DRINKING X $6 =
13 WATER PIPING/DRAIN-IN 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 1 X $25
18 INTERCEPTORS GREASE TRAP,SAND TRAP, • $6
CHEMICAL HOLDING TANK X • _
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =X _
20 MISC PLUMBING FIXTURE - SUBTOTAL
0 CASH 0 CHECK 0 — 0 -.. I PLUS PROCESSING $35.00
FAXED PERMITS WILL ONLY BE ACCEPTED'ITN PAYIiENT FEE
OFA MAJOR CREDIT CARD
TOTAL PERMIT FEE
DUE
DATE: :.`•
BANKCABDNtJ BER417_8117/ .....—_AUTHORIZED SIGNATURE: �—P' ,
, • , • .
ADDREss lo3 4. t) - , A ,
ZONE
R°:RDON; ,.. -' FLANKING.45::.
N COMMENTS ,
REVIEWED BY Wail 4 1.111..A. 4.0
s., -. 1/(
a)
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D .5 mm sae plan is being submitted for th• purpose of u)
obtaining a building pennit and is a true and esweof 2
to representation the proposal. NI known property CO
C\1 *VW• . .curb linos,structures and wiesenents
have 4 , .. Also indicated we * Sandi.
ft . • ',up slopes qrSMrcritical areas. a)
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sired. ir r
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Dale:
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Lexington Homes
Homes
3703 S.Virginia
Pine Rock Rdg .
Lot 4, Block 4 SCALE: 1 " = 20'