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2004, 07-27 Permit App: BLD-04-07174 Residence CC[1BUILDING PERMIT APPLICATION WORKSHEET SMille0"\iCity of Spokane Valley Community Development Department Building Division 11707 E. Sprague Avenue, Suite 106 .000V �e Spokane Valley, WA 99206 Phone: (509) 688=0036; Fax: (509) 688-0037 REQUIRED SITEINFORMATION-- , Street Ad dress: 3q 1 JCf S _ \g' t &! N1.A . Assessor's Tax Parcel Number(s): 9 '1,9 � k-"- I Legal Description: LOT I ..,-K L1 Pir\IE 1 ?L K. RU )( RA C) PERM! DESCRIPTION: . Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home (l Relocation ❑ Tenant Improvement ❑ Fire Safety ri Other OWNER/APPLICANT INFORMATION [1 Owner: ❑ Applicant: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State Zip Code Contractor. ?, I1L' 'b� : /L ❑ Architect: ` ' Phone: w, ' = Pi ,.1� Phone: Fax: As•ress: jMr�p g raii� qZE Address: ,,\, 4 ,l- :I Ci State Zip Code City Stat- Zip Code WA State Contractor License#: X/ Iv H I h, 5.c ontact: r-AL I PERMIT/BUILDING INFORMATION l HEIGHT TO PEAK • DIMENSIONS: c #OF STORIES: /. Cal .1 MAIN FLOOR TO SQ. FTG: irni 7 27 FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG/ A FINISHED BMT T SQ. G. GARAGE SQ. FTG: 543 DECKICOV. PATIO SQ F f G OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: rOP(E b • A r R &-A -) #OF BEDROOMS: 4 TOTAL HABITABLE SPACE: / 547 IMPERVIOUS SURF C A : COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC / SYSTEM? � � 1E�� MANUFACTURED HOME Width: Length: Year: Pit Set: Manufacturer: RELOCATION Previous Address: Proposed User " - FIRE SAFETY Fire Sprinkler: # of Heads: _ Fire Alarm: Paint Booth: Tent: Fireworks Display: Blasting: • Date/Time: 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 1 ❑ BOLTING I I CONCRETE I, I 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#: u orize ignature: • MECHANICAL PERMIT APPLICATION SanorliaOlir:e\110% City of Spokane Valley Community Development Department „,� BuildingDivision ii��jj''{{__)j 11707 E. Sprague Avenue, Suite 106 feySpokane Valley, WA 99206 Phone: (509)688-0036;Fax: (509)688-0037 &) /� FOR INSPECTIONS,CALL(509)688-0054 I Project Address: 3 71 q L ` \J,( . . . )/ ' ` Permit Use: Owner. Phone(Daytime Contact): Mailing Address: _ ;ly , ^ if' � f� F C A �! License#: ) a J • hone ` "`t / Contractor. � A _ � � _ �jc/�C Mailing Address` !-� ( �" ► c �n` State Zip Code %OF a TOTAL UNITS X COST AMOUNT DESCRIPTION OF WORK . E. .1 . .,. . .' „OGO BB $15.00 1 FUEL BURNING APPLIANCE X $19.00 ,�_- 2 FUEL BURNING APPLIANCE More than 100 000 3 UNLISTED APPLIANCE • •-iai Fey E. a:to or less t.-.an 400 000 X $50.00 = IN UNLISTED $100.00 UNLISTED APPLIANCE(Additional Fe.:l_ More than 400,000 II UCED APPLIANCE(WSEC min.AFUEpr less than 400,000 X $50.00 5 ray a i USED APPLIANCE(WSEC min.AFUE Morethan 400,000 X $100.G0 = 6 rrti © 1-100M BTU X $15.00 = El BOILER/REFRIGERATION BOILER/REFRIGERATION 101-500M BTU X $28.00 = , e BOILER/REFRIGERATION 501-1,000M BTU X $39.00 II 10 BOILER/REFRIGERATION 1,001-1 750M BTU X $57.00 II 1111 More than 1,750M BTU X $95.00 II BOILER/REFRIGERATIONII ® X $10.00 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 II® RANGE X $10.00 ell DRYER IIIIIIIIIIIIIIIIRMII III ® � Jt $10.00 FUEL BURNING WATER HEATER III MISC.FUEL BURNING APPLIANCE X $10.00 El GAS PIPING each outlet X $1.00 111111111111 X $10.00 = 18 DUCT SYSTEMS IS X $10-00 VENTILATING FANSII El 20 AIR HANDLER II e ES NOT include dudtn• E•ual to or less than 10,000 CFM X $12.00 . ® AIR HANDLER DOES NOT include ductin• Greater than 10,000 CFM X $1 9.00B 22 EVAPORATIVE COOLERS X $10.00 III $50.00 ® TYPE IHOOD ISX $10.00 IITYPE II HOOD 0-3 TON X $12.00 ® HEAT PUMP/AIR CONDITIONERX $20.001 191 IS AIR CONDMONER 3-15 TON © AIR CONDmONER 15-30 TON X $25.00 II la AIR CONDITIONER 30-50 TON X $35.00 ■ IS AIR CONDITIONER More than 50 TON X $60.00 III X $10.00 30 IPG STORAGE TANK II® WOOD OR PELLET STOVE/INSERT X $10.00 ® WOOD STOVE-FREE STANDING X $25.00 METHOD OF PAYMENT: SUBTOTAL III DATE: PROCESSING FEE $35.00 0 CASH 0 CHECK 0 VISA 0 MC EXPIRES: TOTAL PERMIT FEE DUE: CARD#: AUTHORIZED SIGNATURE: ,. t PLUMBING PERMIT APPLICATION S41361(ane City of Spokane Valley Community Development Department BuildingDivision 11707 E. Sprague Avenue, Suite 106 40101111°ValleY Spokane Valley, WA 99206 Phone: (509)688-0036;Fax: (509)688-0037 • FOR INSPECTIONS, CALL(509)688-0054 Project Address: ` 7 I C S � V a ( C A) 1 A Permit Use: Owner. Phone (Daytime Contact): Mailing Address: . . -- - _.r l • City State Zip Code Contractor.' fr ► "J License#: ' ri ; • Phone#�:n 7V7 -,?() 77 Mailing Address: 7 G,� , m am i< ` ' `,, --1(P ✓1'O AQ,l "g /(r;, City State Zip Code *OF TOTAL DESCRIPTION OF WORK UNITS X COST = AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6.00 = _2_ URINALS X $6.00 = 3 TUBS X $6.00 = 4 SHOWERS1pER TRAP) BATH,STALL,ONSITE BUILT X $6.00 = 5 SINKS LAVS/BASINS,BAR,FLOOR, KITCHEN,LAUNDRY,UTILITY, /— X $6.00 = JANITOR,PHOTO,X-RAY,FOOD, PREP/CULINARY/MEAT J 6 DISHWASHER / X $6.00 = 7 CLOTHES WASHER / X $6.00 = 8 GARBAGE DISPOSAL / X $r.00 = 9 WATER SOFTENER X S6.00 = 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 $8.00 = 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 BB,STEAMER,PROOFER, X $6.00 = CARBONATOR,SWAMP COOLER ‘ 17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND RP.B.P.D.FORI X $8.00 = 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: —__ — — Property Line c7 _____------7-r, c.. 15' FromCente , a . ' " /_ of Road \.1\RVCom '" ' 0)1 `e.s de T_nderground CURB1 } - } N " � -- �''~-~ d } i �- Utility ` o .o � - } t } a t ,, , � % Easement i - t a, Driveway �; } i t.t 7, '� % ,, t iti I mo+ +- 2_,;:, ' } r11-1 • } 25` Bldg , r _ ► -t r , 1-..4--'- Setback t } >0 r } c 1 + • t, 1 \ 1 o t, ' R, , garage • , , 2 53INe., , FRONT �, - I , 6111114 } v \--L, . v.-9,l ' -I 55 \\ , 1 house .\ }\, I } 1 12 `\ } It \..,,_,,.--- ---1.-••'"" ^ \'• \ 11'-0"4 --j* Conc. �` '} o, patio c.,-, , 11 `\\, }t` I } I m '. \ 1 U •p '} \\ i I • 111 L -i \ 1 obta� 13441.11.7:\ M___ Ot 1 repre - ;' Panllt 11W Is�lew�j�f10 Oaf1 I Q.. line .. Pt000�1, Al 1 w _-/ 8Ve •• • ' "rine a�_ 11 j t 9 Ot t / Mld1, PINE ROCK RIDGE 1ST ADDITION \\4.1/4 .. LOT 1 BLOCK 4 Founded 1946 0 10 20 40 6. ,��■.� imp son Engineers, Inc. CIVIL ENGINEERS & LAND SURVEYORS N. 909 ARGONNE ROAD, SPOKANE WA., 99212-2789 SEPTEMBER 2003 PHONE (509) 926-1322 FAX (509) 926-1323