2004, 03-05 Permit App: BLD-04-03700 Residence San**polariel\l'a
.010Valley PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
� � BUILDING DIVISION
11707East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688-0036 Fax. 509 37
REQUIRED SITE INFORMATION
`
STREET ADDRESS: Al1:q4=i4d ,Alf_-' I '
ASSESSOR'S TAX PARCE NU ER(S):
LEGAL DISCRIPTION: ---- -------73 4n i 1i
of Q/ -( k._,/'.4'j T3' 11 D
PER DESCRIPTION: V
ULLDING PERMIT C1 CHANGF IN USE - 0 GRADING .0 MANUF'ACCruRMD HOME
0 RELOCATION U SIGN [TENANT [3-OTHER• OWNER / APPLICANT INFORMATION
0 OWNER: 0 APPUCANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
e CITY,ST E,ZIP CITY,STATE,ZIP
O CONTRACT• 1
If Alt L..� 4 I , a ARCHITECT: -
PHON 1 �. i. lI PHONE: FAXADDRESS: :.&i.�1t# ADDRESS:
lizi ,/.$TATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE#rzya�6,� �p CONTACT:
PERMIT/BUILDING INFORMATION -
COST OF PROJECT: 30%SLOPES ON PROPERTY: NO(1 MAIN FLOOR SQ FT:- 5610--, -
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2N0 FLOOR SQ FT: q Li`U,
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNPIN BASEMENT. t 0 ON 5
• NUMBER OF STORIESif.V_-(� STRUCTURES ON PROPERTY: 0 FINISHED BASEMENT: Liq
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: 7 /0
FLANKING SETBACK: CURRENT PROPERTY SIZE: I:V"I COVERED DECK:
a
FRONT SETBACK: CURRENT PROPERTY USE: V ,�. � k
QD : `(1
REAR SETBACK: CURRENT SEPTIC USE: /"�
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: •
o
4.00100'A.
. Valley
MECHANICAL PERMIT APPLICATION
PROJECT i � v-cil • 'PERMIT
ADDRESS: 3 7 b 4al -OWNER: � PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) •(zip)
co f i ►IS
j E A _ Ji �C6
MAIUNG AD6R SS: PHONE#:
401g 6), e/A,A,,,t, .„,,,,,,,,
• 7
(street) (city/state) (zip)
DESCRIPTION OF WORK #of.Nas X COST EQUALS AMOUNT
1 FUEL.BURNING APPLIANCE =ORO 00,000 / X $15 =
2 FUEL BURNING APPLIANCE >100.000 $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR400,000 X $50 _
4 UNLISTED APPLIANCE(ADDITIONAL FEE) *400,000 X $100 is
5 USED APPUANCE(WSEC mit.AFUE rating) =OR<400,000 X $50 NB
6 USED APPUANCE(WSEC min.AFUE rating) >400,000 X $100 =
7 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION • 101-500M BTU :: $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 _
13 RANGE - A $10 =
14 DRYER - X $10 . _
15 FUEL BURNING WATER HEATER - X $10 is
16 MISCELLANEOUS FUEL BURNING APPL • - X $10 =
17 GAS PIPING(ea.Outlet) - X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - x $10 =
20 MR 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 - S 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 MR CONDITIONER +50TON X $60 =
30 LPG STORAGE TANK - • X $10 ,
31 WOOD OR PELLET STOVEANSERT - X . $10 =
32 WOOD STOVE-FREE STANDING - X $25 . _
•
- —
• : . SUBTOTALc
a.
0 CASH 0 CHECK 0 11111111111111i
0 -"'"L` 1 PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYLSENT FEE $35.00
OFA MAJOR CREDIT CARD .
TOTAL PERMIT FEE
DUE
DATE: • EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
I pOkane
......*Valley
q • PLUMBING PERMIT APPLICATION
!,C
ADDRESS: L-.1 A' V USE
—OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (zip)
C• "' .CIOR: z . / / . - LICENSE#:
4 pI
ja
A.' X18KO
ADDRESS: NE#:
10.E - 4D 7q
170 ,s. me. le/Rid
(street) (city/state) (zip)
•
• PLUMBING"FIXTURES
_ DESCRIPTION DETAIL`' #OF wars X COn.`ALS AMOUNT
1 TOILETS • :PATER CLOSET,BIDETS ,3 X $6 a .
2 URINALS X $6 =
3 TUBS 0,c, X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILTX $6
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6'
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
_
6 DISHWASHER X • $6 =
. 7 CLOTHES WASHER / X $6 sc
8 GARBAGE DISPOSAL / -, X $6 =
9 WATER SOFTENER X $6
10 ELEC HOT WATER TANK NOTE:IF GAS SEE MECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, $6
CONDENSATE / X 4 =
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
a
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 • a
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6
20 MISC PLUMBING FIXTURE •
X $6 =
- - - - _ SUBTOTAL .
❑ CASH ❑ CHECK E1 . 1amk 0 -- = -.! PLUS PROCESSING
PARED PERMITS WILL ONLY BE ACCEPTED WTTH PAYMENT $35.00
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
DUE
DATE:
BANKCARD NUMBER: •
AUTHORIZED SIGNATURE:
A -
This site plan is being submitted for the purpose of
N obtaining a building permit and is a true and correct
lopresentation of the proposal. All known property
i 1'esidimensions,curb lines,structures and easements
have b- •• identified. Also indicated are wetlands,
bodies • r, steep nuts other critical areas.
Signed: t' Y `w l
Date: 3- / -0
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ROAD WIDTH 30
FRONT , ' FLANKING
COMMENTS _
Lexington Homes AEVIEWEDSV 91111 _1 ,�,�� ,
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370q Virginia
Pine Rock Rdg .
Lot 3, Block 4 SCALE: 1 " = 20'