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2003, 05-19 Permit App: BD03-466 Residence City o f (gig'X103 Cp SPOKANE VALLEY • r X (vl,0o37 PERMIT # 5 D o-3- rr+-(cam . 3 B I DING PERMIT APPLICATION ` Box-1 OWNER biet no4dACR CSS-4.TOB LOCATION //a 3. Xi 6 5va OWNER'S ADDRESS/5.73..? I C CITY' PHONE /44,.55if / Ve✓o- ccl•e 9,7y— 'L/ DESCRIBE JOB ', ( THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. . 30X 2 CONTRACTOR'S NAME , � zleirle_S7` PHONE y,,?9'- �6' cf' CONTRACTOR'S ADDRESS CITY CONTRACTOR'S REG.# EXPIRATION DATE I • (CARD MUST BE PRESENTED AND COPIED OR VEF�IFIED) 30X 3 CONTACT PERSON OF PROJECT ✓1 r 5 [� ni''�:C-l�r} PHONE �oC 7! J7c���� ADDRESS CITY ZIP 3OX 4 SEWER AVAILABILITY ,...-_40WATER AVAILABILITY /2,e9 SOX 5 ESTIMATED PROJECT COST$ ,or,--,,,,EXISTING BLDG.VALUATION$ ,OX 6 PROPERTY TAX ACCOUNT NUMBER . LEGAL DESCRIPTION I (IF NECESSARY, PLEASE SUB IT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) F • CENSUS NUMBER LO NUMBER DX 7 BUILDING SQUARE FOOTAGE Existing/proposed) 1ST FLOOR 0 /I/s-s/2ND FLOOR 0/ 3RD FLOOR I[J / el OTHER ,o - I 0 BASEMENT FINISHED / BASEMENT UNFINISHED " / , DECK / / I GARAGE / 7C,4 CARPORT 0 / 2 TOTAL / HEIGHT TO PEAK OF BUILDING FT. ' )X 8 ( ) SINGLE FAMILY (�) MULTIFAMILY(NO. OF UN TS ( () NEW CONSTRUCTION ( ) COMMERCIAL/ INDUSTRI L ) ( ) EXISTING STRUCTURE TOTAL AREA OF PROPERTY � y ` SQ. FT. ( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE- p�I ` .XPi_ SQ. FT./ �..s )X 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES . PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES, SYSTEMS, HEATING AND AIR U ITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS, LAWN SPRINKLER SYSTEMS, B CK FLOW PREVENTERS, ET AL 11 X 10 Water Service meter size af known) 5Ali/ Also see BOX 4 X 11 Septic Tank—Not generally allowed in the City of Spokane Valley. For special circumstances contact Your sewer purveyor and t e Health District (See BOX 4) X 12 Street use may require a" treet Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. -RIFY UNDER THE PENALTY OF PE JURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND RRECT TO THE BEST OF MY KNOW EDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE DVE PREMISES TO PERFORM THE ORK FOR WHICH THE APPLICATION 1S MADE. NER/AGENT l /C���-2 DATE f rn% mvFRI • I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: Visa Mastercard ---- ---- Expiration Date Print the name of the holder Signature • ------=--------------- ' OFFICE USE ONLY-PLEASE DO NO -------------- T WRITE BELOW THIS LINE =============================================================== ZONE SETBACKS: FRONT• SIDE • REAR HEIGHT LIMIT i PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE REMARKS • SEPA: EXEMPT NOT EXEMPT FIRE DEPARTMENTIJkPPROVAL DISAPPROVAL DATE REMARKS • PUBLIC WORKS DEPARTMENT APPROVAL - - DISAPPROVAL DATE RESIDENCE TYPE OF JOB; NEW ADD/ALT --- — NEW INDUSTRIAL IND.ADD/ALT• NEW COMMERCIAL - COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS MULTIFAMILY ADD/ALT TENANT IMP. ROOF OCCUPANCY TYPE OF CONSTRUCTION • STORIES E BUILDING SQ. FT. @ — BUILDING SQ. FT. @ = BUILDING SQ. FT. @ — BUILDING SQ. FT. • @ — TOTAL SQ. FT. TOTAL VALUATION. BUILDING PERMIT NO. PLAN.CHECK FEE REC'D RECEIPT NUMBER PERMIT FEE •PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE • ENERGY SURCHARGE OTHER CHARGES I • AMOUNT DUE BUILDING DEPARTMffNT APPROVAL . 'BY DATE • • ASSIGNED ADDRESS • i• 1 • `anti of spatia a 11707 E. SPRAGUE, STE 106 .00ValleySPOKANE VALLEY, WA 99206 (509)688-0036 FAX(509)688-0037 PROJECT TRANSMIIIAL: TRANSMITTAL DA'Z'E: O C u' SITE INFORMATION t CirMAIIM D PERMIT INFORMATION Site Address: i 1 41'3 N) , 0 I I I\ Permit Number: f3D 3 14( ,Issue Date: Permit Use:-F', 5 , k,\NC,AR , Parcel Number: Applicant: DA , �� Subdivision: Block: Lot: Phone: q 2.4 ,c390 Zoning: Water Dist: Contact: D ENO is CPA FD Owner: D i A MOOD l' Phone: Address: ► c3 a I , N\ ISS 101\) Contractor: 'J ERPnPLP_ Building Inspector: 6 A v_`- 1-\ ► Setbacks-Front: Left: Right: Rear: APPROVALS1 ii ‘ l A �Z BUILDING ► J /{olla ) It 71 L. / I .-..) PLANNING: �.t c „e_t- ENGINEERS: Q /. 111t� (CO 6 3.22 7 60 HE H: SEWER: L FIRED T= �= APPROVALS WATER DIST': STORM/WATER: 0/R: ( 5S? Q 7 7,933 , 11 :1;7* SPR , ic,,Q 11peLe flc-- /45 7 , 1, O 79 .i4o 2 . Ft_ - .` ©o crr4 c:e O'er ��� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone p% .ne Spokane Valley,WA 99206 509-688-0037-Fax 40000 Valley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: p 3 xj n V A ` USE: OWNER: , _jam; /y PHONE(Daytime Contact): 4,. MAILING ADDRESS: / /5-3,..,?/ �' fr, --ssm` ai /e re,da 4 9 9) 3 7 (street) (city/state) (ZIP) CONTRACTOR: n ( C LICENSE#: U a rti0NO� /C� MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) ' PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS a X $6 _ 12 2 URINALS X $6 3 TUBS 2 X $6 /2 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 - ie RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER t X $6 - (..t.)7 CLOTHES WASHER i X $6 - 8 GARBAGE DISPOSAL I X $6 (.r 9 WATER SOFTENER X $6 - 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X $6 - - 12 FOUNTAINS,DRINKING X $6 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, WASTE,VENT,PLUMBING REVERSALS X $6 - REVERSAL 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, STEAMER,PROOFER,CARBONATOR, X $6 - / SWAMP COOLER V 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR:VATS,TANKS,BOILERS x 17 SPRINKLER SYSTEM X $25 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 20 MISC.PLUMBING FIXTURE X $6 - SUBTOTAL: 7g on METHOD OF PAYMENT :Cast PLUS PROCESSING FEE: $35.00 ❑ CASH 0 CHECK 0 Man 0 L........:1-...1' _ , TOTAL PERMIT FEE DUE: J prk / i, DATE: EXPIRES: BANKCARD NUMBER 1UTHORIZED SIGNATURE: S(mart c. 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone pokane Spokane Valley,WA 99266 509-688-0037-Fax ....*Valley For Inspections, call 509-688-0054 'Mechanical Permit Application PROJECT PERMIT ADDRESS: 1 0 3 JJ i 9' S- - . USE: OWNER 0 t ,�^ i&t.YU r„-vt4 ! X J� -?,,i-),7‹4, PHONE(Daytime Contact): MAILING ADDRESS: l5-3. l 6, 4/,. s/ 14,(-6 da_ /e 96-3-7 (street) (city/state) (ZIP) CONTRACTOR: b , Get �� LICENSE#: C1 r!G s MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE =OR<100,000 / X $15 = 14- 2 FUEL BURNING APPLIANCE >100,000 X $19 = 3 UNLISTED APPLIANCE(ADDITIONAL FEE) =OR<400,000 X $50 = 4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 = 5 USED APPLIANCE(WSEC min.AFUE rating) =or<400,000 X $50 = 6 USED APPLIANCE(WSEC min.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 = 13 RANGE - X $10 = 14 DRYER - f X $10 = 10 15 FUEL BURNING WATER HEATER - X $10 = %0 16 MISC FUEL BURNING APPL. - X $10 = 17 GAS PIPING(ea.Outlet) - X $1 = 18 DUCT SYSTEMS - X $10 = 19 VENTILATING FANS - X $10 = 20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 = 21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 - 22 EVAPORATIVE COOLERS - X $10 = 23 TYPE I HOOD - X $50 = 24 TYPE II HOOD - I X $10 = ie) 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 +50 TON X $60 = 30 LPG STORAGE TANK - X $10 = 31 WOOD OR PELLET STOVE/INSERT - X $10 - 32 WOOD STOVE-FREE STANDING - X $25 = SUBTOTAL: . C METHOD OF PAYMENT PLUS PROCESSING FEE: $1C.035..00 MiMilli i TOTAL PERMIT FEE DUE: c' 00 0 CASH 0 CHECK 0 0 '.__-.---- _ DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: City of SPOKANE VALLEY Building, Fire a ci Public,Works Fees Receipt /�-�II_� Applicant/Business Im 1 , Ra& (fJ S!'c Permit No. d?j'L-�•l Project Name Date g-(v, Site Address .1 I 0 3 NJ V 1 S'S'A Please Receipt the Following: = Check Number . Receipt Number Payer's Name 1>1 F•c9C Address • City Zip BUILDING DEPARTMENT 001.059.322.10.01 Building Permit $ e Z . 7S- 001.059.322.10.02 Plumbing Permit $ I 1 001:059.322.10.03 Grading Permit $ 001-09-322.4 0.04 "Mechanical Permit $ .g a , oc. OO 159.322.'0:o6 Demolition Permit $ 001.059.322.90.01 Misc. Permits and Fees $ 001.059.345.83.01 Plans Check Fee . $ . 71 , (S 001.059.345.83.03 Energy plans check fee • $ 001.059.342.40.02' SPECIAL Inspections $ 001.059.237.10.98 Bonds / Deposits $ 001.059.237.10.02 WSBCC Surcharge * $ FIRE DEPARTMENT # • 001.059.322.10.07 Plans check fee 001.059.322.10.08 Sprinkler plans check $ 001.059.322.10.09 F. A. Plans check $. 001.059.322.10.10 Misc, plans check $ 001.059.322.10.11 Fire Alarm inspections $ 0010.59.322.10.12 Sprinkler inspections $ 001.059.322.10.13 Misc. Inspections $ 001.059.321.30.00 FireWorks Permit $ 001.059.342.40.01 UFC permit fees $ 001.059.237.10.99 Bonds / Deposit ** $ OTHER: $ • $ PUBLIC WORKS • 001.059.322.40.00 Right of Way $ 2� ,cab 001.059.342.40.03 Special Inspections $ 001.059.237.10.99 Bonds/Deposits (cash)** $ TOTAL AMOUNT DUE $ /221 q, A • * To be sent to Wash. State Building Code Council quarterly. # 65% of figure to be sent to the Fire Department Quarterly, except bonds etc. ** Liability Insurance verification may also be required. • s-vrecpt • • Call 24 hours before inspection required crrt Phone 509.688-0036 Fax 509.688-0037 Spokane ley DEPARTMENT OF PUBLIC WORKS Anticipated start date Permit # PW -�Z7 APPROACH PERMIT APPLICATION `S Location of property 1C3 • (Address/parcel #, if available) Applicant Name Dr AN d P\c] C_o 0-1 Address \ 32._c E Phone ' (4' c-ffl C.01-\ Contractor's Name Address Phone Contractor's Reg# Expires PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Commercial/Industrial Driveway Existing Curb & Gutter Rural Road Section nCulvert Installation Sidewalk Repair/Construction Other conditions See construction requirements and details on reverse. Bond/insurance certification must be on file with the City. SPECIAL CONDITIONS: PERMIT FEE $ ,cam Inspection Fee$ I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card. Card# Expiration Date Name of Holder Signature Fees Paid$ j. Date Excerpts from Spokane Valley Standards (3.24, and details A8 and A-8a): • Every driveway approach must provide access to an off road parking area located on private property.The driveway shall be of sufficient length so a vehicle in the driveway does not project into the road right of way, sidewalk, or pathway. • Public or private driveways in industrial, commercial, multiple family, church or any like use shall be constructed to allow vehicles to exit without backing onto a public road. • Driveway approaches shall be constructed to avoid interference with existing drainage inlets, culverts, road lighting standards, utility poles,traffic regulating devices,fire hydrants or other public utilities. The applicant shall bear the cost of relocating any such public facility. • Driveway approach grades within the right of way shall not exceed 8% in urban area, or 2% in rural areas. Driveway grades shall not exceed 10%within ten feet of a city right of way. See Standards for a more complete listing of requirements. • • 11 I !l i pi Z i1 `. • TII I1 g t g W IIdis < ill €l +, Zltl d i I S E- S IIS �` s \ / k ¢ ` .i C z . W R_ biz Ifi ,�t I - I�s7 1 7 _ S ��I < 0 Iii IL 1 G1 4i W 4 X Lb 1111‘'1116, V---- -e '41E 11 < OCC be 1- II Gb a! -�- "I a L —__ 1t 4 bi 1 4 1z / / I $ VI I b, '9,zebb us 1 1 _ IGP 1� II- I see taO Z_1ZZ I H . W ! if.- N f O N HU Ill no- ll" ur CZ�' 2001 WSEC.Residential Compliance Form f� Prescriptive(Chapter 6) Options for all R Occupancies, Climate Zone 2 0 I Heat source: ALL SPOKANE VALLEY BUILDING DEPARTMENT • • 11707 E.Sprauge Avenue,4106,Spokane Valley, Washington 99206-Tel 509-921-1000-Fax 509-921-1008 SITE ADDRESS: //0.'JO . Vf $122 PERMIT NO. DATE: 5-7(1/0 INSTRUCTIONS - 1) Your permit will be processed more efficiently if you provide all of the requested information. Department staff can help you with general questions about this form. Your building must match the selected option requirements without •exceptions or substitutions. 2) Glazing percentage determines which option to choose. Complete the following glazing area calculation before proceeding to the option table below. GLAZING AREA CALCULATION: SF. _ /lS7 SF. = At I/% % I TOTAL WINDOW AREA _ HEATED FLOOR AREA (ALL FLOORS) _ % OF GLAZING NOTE: Use rough opening(R/O) for window area. Include all half-lite and full-lite door glazing in this calculation. • CAN'T COMPLY? If none of the Prescriptive(Chapter 6)Options below are acceptable,consider systems analysis (Chapter 4)-or,Component Performance (Chapter 5) Approach.The main advantage is flexibility to juggle individual U- factors (R-values) as long as an overall maximum value isn't exceeded. Note that the overall perfot'mance requirements are no less stringent than the Prescriptive requirements. Calculations may be performed by hand or, using an acceptable computer software program. Helpful forms and other resources can be downloaded at http://www.eriergy.wsu.edu/ buildings. 5K1 (leiki- • S •�-�{ Glazing Glazing U-Fact . Wall* LJ Option Area":%of / Door' Ceiling Valuted Wall Wall*int ' Vertical Overhead" U-factor = r Above Below ext Floors Stab on Floor Cerhng Grade Grade BeIOW ' Grade • Grade . y 0 I. 10% 0.40 0.58 0.20 R-38 R 30 R-21 Z int' R-21 R-12 R-30 R-10 d. • l '( :-1 ❑ It.' 15% 0.40 0.58 0.20 R-38 R-30 R-19+ Res R-21 . R-12 R-30 R-10 O A r40 Ill. 17% 0.37 0.58 0.20 R-38 R-30 R-19+ > R-56 R-21 R-12 R-30 R-10 V O Unlimited pay iv. • Group R-3 0.35 0.58 0.20 R-38 R-30 R-21 A. • Occupancy inti R-21 R 12 R.30 R-t0 g f0 E. 0. Nom nal R-values are for wood frame assemblies only or assemblies built in accordance with Section 601.1 1. Minimum requirements for each option listed. For example,if a proposed design has a glazing ratio to the conditioned floor area of 13%,it U� x shall comply with all of the requirements of the 15%glazing option(or higher). Proposed designs,which cannot meet the specific �./ U requirements of a listed option above,may calculate compliance by Chapters 4 or 5 of this Code. W m 2. Requirement applies to all ceilings except single rafter or joist-vaulted ceilings. 'Adv'denotes Advanced Framed Ceiling. W 3. Requirement applicable only to single rafter or joist vaulted ceilings. rLf Q 4. Below grade walls shall be insulated either on the exterior to a minimum level of R-12,or on the interior to the same level as walls above grade. Exterior insulation installed on below grade walls shall be a water resistant material,manufactured for its intended use,and installed CG according to the manufacturer's specifications. See Section 602.2. F 5. Floors over crawl spaces or exposed to ambient air conditions. • H (/ 6. Required slab perimeter insulations shall be a water resistant material,-manufactured for its intended use,and installed according to X manufacturer's specifications.- 7. Int.denotes standard framing 16 inches on center with headers insulated with a minimum or R-5 insulation. 8. This wall insulation requirement denotes R-19 wall cavity insulation plus R-5 foam sheathing. 9. Doors.including all fire doors,shall be assigned default U-factors from Table 10-6C. 10. Where a nexirrurn glazing area is listed,the total glazing area(combined vertical plus overhead)as a percent of gross conditioned floor area shall be less than or equal to that value. Overhead glazing with U-factor of U--4.40 or less is not included in glazing area limitations. 11. Overhead glazing shall have U-factors determined in accordance.with NFRC 100 or as specified in Section 502.1.5. 12. Log and solid tinter walls with a minimum average thickness or 3.5"are exempt fprm this insulation requirerren t , \ Form 5-050801-2001 Residential Comp Form • 2001 WASHINGTON STATE ENERGY CODE UPDATE This brochure is provided to assist in deciphering some of the Energy Code updates, and focuses primarily on RESIDENTIAL changes of significance. This notice does not contain all of the changes occurring in the 2001 WSEC. ■ Chapter 6,Prescriptive Requirements Approach—The code is now fuel-blind. Two tables (6-1,.6-2) replace six previous tables. Table 6-2 is applicable in Climate Zone II,Eastern Washington. ■ Table 6-2 offers four options to achieve compliance based on the percentage of glazing in the home. Two • options (I,IV) require wall insulation values of R-21,the remaining two options (II,111) require R-19 + R-5 foam sheathing. There are no substitutions permitted for the foam-sheathing requirement in Options II, III. *Hint:If your home design falls within the parameters of Options II or III,you may select option IV thus permitting unlimited glazing area with U-factors of 0.35 or better. The benefit: you may then use the R-21 batts for wall insulation. • Glazing U-factors of 0.40 are the minimum efficiency requirements for windows, and some instances may require U-factors of 0.35. • Minimum door U-factors are 0.20. • Options I and IV require headers to be insulated to R-5 minimum. • • Ceiling insulation R-values have not changed. • Compliance through Chapters 4 and 5 (heat loss calculations) may still be used, however,the Wattsun program is being phased out. A new spreadsheet will be available soon through the WSU Energy Extension Program and will be available on-line at: www.energy.wsu.edu/buildings/.In the mean time, if you use the Wattsun software it must be version 5.7 for acceptance. Note:It will be increasingly difficult to show compliance with un-insulated basement walls. REMINDER— VIAQ/WSEC REQUIREMENTS 2ompliance has been off the mark in the following areas of the Ventilation &Indoor Air Quality Code/Energy :.odes since they became effective July 1, 2001. • Labels must be provided on the whole house ventilation controls (e.g.; 24 hour timer), which read: "Whole House Ventilation (see operating instructions)." Instructions must also be provided for the homeowner describing the Whole House Ventilation System's operation. • HVAC ductwork/furnace cabinets outside the conditioned space (attic, crawl space, garage) or stud bays,joist cavities/spaces used to transport air must be sealed with welds, gaskets, mastics or mastic-plus-embedded-fabric systems. UL 181A tape is permitted for rigid glass ducts, and UL 181B tape is permitted for flexible ducts. Common duct tape is not permitted unless:the HVAC equipment (air handler in the case of heat pumps) and ductwork are located entirely within the conditioned space. • ONLY ONE FORM .ttached is the new Washington State Energy Code Compliance Form containing Table 6-2, which reflects the pcoming insulation values. This form must be used if you choose to comply by the prescriptive approach (no Ilculations necessary). This must be completed prior to receiving your permit. • )r questions and information regarding these changes please contact our office at:477-3675, or visit Washington State niversity Energy Extension Program web site:www.energy.wsu.edu/buildings/. 3d 00, -i.;„ „ . E' Cars i ! 4 ! i f Pcki vi L0.4- a • / (o3 /fid APPROVED BY - CERTIFICATE OF SEWER AVAILABILITY This form is only to be submitted as an attachment to a fully completed application. Name of Sewer Utility: CERTIFICATION Project Name: r,y-Li V l S 1:„-( 2 /'M. 1 1 O 3 Vrs% 2040 Parcel Numbers: General Project Description: The above named Public Sewer System is capable of and will supply sewer service to the referenced project or subdivision. 1. Is sewer currently available,with service connections provided as required, to s • e proposed development(If yes, go to signature block; If no, go to 2a) 4,4 es ❑ No 2a. Is the site within the Spokane County Sewer six-year Sewer Capital Improvement Program? •(If no, go to 3) 0 Yes 0 No 2b Will the developer design, fund, construct and provide financial surety for the necessary systems to provide Dryline Sewer and/or Double Plumbing Dry Side Sewers as required? (If no, go to 3) ❑Yes ❑ No 3 Will the developer design, fund, construct and provide financial surety for the necessary systems to extend sewer service to the site and provide service connections as required? ❑Yes 0 No This Certificate of Sewer Availability Is non-transferable to other projects and shall be valid as long as the referenced project remains active and is not modified. Certified by: i5ILLY L.LY U -VW S(4 Pox) 2 teu./f 7P. Print Nam Title 5.Zv.03 Signa Date CONCURRENCY DETERMINATION If yes to question 1, or question 2b, or question 3 above, concurrency is satisfied for sewer. Otherwise, refer applicant to the Division of Utilities. ❑This development is exempt from concurrency for sewer service. ❑This development(does/does not) meet the concurrency requirements for sewer service. circle one Spokane County Representative Date CITY OF SPOKANE VALLEY Cert of Sewer Avallabllity.doc 01/09/02