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2003, 05-15 Permit App: BD03-434 Residence City of �Ll (0W-003 Cp SPOKANE VALLEY . 0'-V 1iFoe PERMIT BUILDING PERMIT APPLICATION Box1 OWNER D � i4�"-4 r % em.S� JOB LOCATION f/05�/�l�• as ( OWNER'S ADDRESS CITY PHONE qzyg-�6 y DESCRIBE JOB ,5 j THIS PROPERTY IS OWNED BY: SINGLE/MAgRIED l/ PARTNERSHIP CORP. ' RP BOX 2 CONTRACTOR'S NAME ��/4, (L PHONE CONTRACTOR'S ADDRESS /5-327 �,e CITY V e re 0/44-tc. CONTRACTOR'S REG.# i4 Intar '� .3 Ze) Q EXPIRATION DATE / Z ?gid L( (CARD MUST BE PRESENTED AND COPIED OR VE IFIED) BOX 3 CONTACT PERSON OF PROJECT pea/11.�j rq/�a PHONE O'$ S v ADDRESS CITY �` ZIP BOX 4 SEWER AVAILABILITY !�L WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION$ BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) I CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR/2O2/ — 2ND FLOOR 'T 3RD FLOOR —/ OTHER / Cd f /S,A-cc B u ' ' • / DECK / GARAGE CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING .1 I'/ FT. 30X 8 (SINGLE FAMILY ( ) MULTIFAMILY(NO. OF UNITS ( �EW CONSTRUCTION ( ) COMMERCIAL/INDUSTRIAL ) � ( ) EXISTING STRUCTURE ( ) TENANT IMPROVEMENT TOTAL AREA OF PROPERTY 7 79/ SQ. FT. IMPERVIOUS SURFACE ! SQ. FT. • 30X 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 UNITS, FIREPLACE INSERTS,WATER HEATERS, CONVERSION BURNERS, LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL: f i_ OX 10 Water Service meter size(if known) %Z i� Also see BOX 4 OX 11 Septic Tank—Not generally allowed in the City of Spokane Valley. For special circumstances contact Your sewer purveyor and the Health District (See BOX 4) OX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. /ERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND • DRRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE 30VE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE. NNER/AGENT c ` Jf Q DATE (5--c:>3 (OVER) 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 Folder Signature • OFFICE USE ONLY-PLEASE OO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT SIDE 5 ( REAR HEIGHT LIMIT PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE REMARKS SEPA: EXEMPT NOT EXEMPT FIRE DEPARTMEN4PPROVAL DISAPPROVAL DATE REMARKS -J PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE TYPE OF JOB: NEW RESIDENCE �/ RES.ADD/ALT NEW INDUSTRIAL IND,ADD/ALT NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER OCCUPANCY TYPE OF CONSTRUCTION / STORIES `l E BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ BUILDING SQ. FT. @ — TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NC. 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 n AMOUNT DUE BUILDING DEPARTMffNT APPROVAL . BY DATE ASSIGNED ADDRESS • 1 tan' Ipo ne 11707 E. SPRAGUE, STE 106 Vau ey SPOKANE VALLEY, WA 99206 (509)688-0036 FAX(509)688-0037 PROJECT TRANSMITTAL: TRANSMITTAL DA1't✓: SITE INFORMATION PERMIT INFORMATION Site Address: %;D T I J U( -L Permit Number: B Q O3 -/3 Issue Date: Permit Use: es f c /Cz ov-ce c� P Parcel Number: L./3--/ (2. C' O 1 Applicant: nLjyt Or- Subdivision: TOci et- ' V l_Skc-U Block: Lot: 3Phone: Zoning: Water Dist: Contact:0 n 5 ( _c P C) Owner: r Phone: ^��J 62 Address: 153 a i 141-ss' Contractor: F r �& t.�.J 16t oft CJt,CX Building Inspector: IJ CA r r. Setbacks-Front 5- Left:- Right 5 Rear: saj APPROVALS BUILDINGS: / / /71.5 PLANNING• -< ENGINEERS: P l J 0 3 0-O .. .)• 6//(o /65_ RE7t: SEWER: 0 EbtA BJkO i FIRED APPROVALS WATER DIST• STO ' `WATER: OT ER: 3 ‘,2 q ,i(3 pi .40 - + 51) . � ��— c( : � Le �v L t-N o a Appyc� . City of SPOKANE VALLEY Buildiki g, Fire arl9i P bJic orks Fees Receipt Applicant/Business O�),G:m � , Permit No. ,Q 0 03-- V'E ' Project Name Date ;--a.2_o Site Address //©S ,1/ 44,s Please Receipt the Following: = = =_ = Check Number . Receipt Number Payer's Name Address City Zip BUILDING DEPARTMENT 001.059.322.10.01 Building Permit $ g, ' 7-57 •001.059.322.10.02 Plumbing Permit $ 6 6 oa 001:059.322.10.03 Grading Permit $ 001.059.32 10,04 .Mechanical Permit • $ 7 ' e01:059.322.1"0:06 b e.moiition Permit $ 001.05'9.322.90.01 Misc. Permits and Fees $ 001.059.345.83.01 Plans Check Fee 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 * $ Wl 5-0 • FIRE DEPARTMENT # • ;. 001.059.322.10.07 Plans check fee . $• . > g/, 95- . 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 $ 001.059.322_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 • l 001.059.322.40.0 /V 121 #1 . 001.059.342.40.03 Special Inspections $ 001.059.237.10.99 Bonds/Deposits (cash)** $ TOTAL AMOUNT DUE $ 4Lc .20 •* 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 • a. Call 24 hours before inspection required Phone 509.688-0036 Fax 509.688-0037 Spokane 40,Valley DEPARTMENT OF PUBLIC WORKS 03- Anticipated start date Permit # PW 2O APPROACH PERMIT APPLICATION ler ci— 3 Location of property 1/05- / cf.5 (Address/Parcel #, if available) Applicant Name4'rno d t k Address /53 2 t Etss/;r/ Phone QZ`1 Contractor's Name Address Phone Contractor's Reg# dam. / ',n.0 co 32p Cry Expires 5-1/ZAL-1 PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Commercial/Industrial Driveway Existing Curb & Gutter Rural Road Section Culvert 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: eye' PERMIT FEE $ a2.5„` Ins section 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$ Date mit SCITY(Iry,/ u4u� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone potane Spokane Valley,WA 99206 509-688-0037-Fax Walley For Inspections, call 509-688-0054 -Mechanical Permit Application PROJECT PERMIT ADDRESS: t 3 USE: S�2 OWNER: PHONE(Daytime Contact): MAILING/ADDRESS: , `K,V' p Q / 5301 /�/AtISS/d/\ Al-e— Y/-e'rrt441e .t 7 Co-,- (street) DQ ry) M-61 (city/state) (ZIP) CONTRACTOR: /n� LICENSE#: 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 - )S- 2 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 - ) X $10 - IV 15 FUEL BURNING WATER HEATER - ) X $10 - /(.") 16 MISC.FUEL BURNING APPL. - X $10 - 17 GAS PIPING(ea.Outlet) - _3 X $1 - 18 DUCT SYSTEMS - X $10 - 19 VENTILATING FANS - _� g X $10 - C' ; 30 • 20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 = 21 AIR HANDLER(DOES NOT Include ducting) >10,000 Cnt X $19 - 22 EVAPORATIVE COOLERS — X $10 - 23 TYPE I HOOD - X $50 - 24 TYPE II HOOD - (' X $10 - ) Co 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 $25 - SUBTOTAL: 7"6 METHOD OF PAYMENTPLUS PROCESSING FEE: MOM TOTAL PERMIT FEE DUE 2 s-©a ❑ CASH ❑ CHECK ❑ Mini ❑ '• -...:-.2-&.1 DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: Call 24 hours before inspection required Phone 509.688-0036 Fax 509.688-0037 Sfitane fey DEPARTMENT OF PUBLIC WORKS 03- Anticipated start date Permit # PW 2O APPROACH PERMIT APPLICATION 3 Location of property //05.- AA cit$ c , > (Address/Parcel #, if available) ( Applicant Name �y'/4'rnan et t k Address /5-3 2 r e _s i Phone q2`I ‘`/ Contractor's Name Address Phone Contractor's Reg# dam!gun.& co 32o CR Expires .12A Li PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Commercial/Industrial Driveway Existing Curb & Gutter Rural Road Section Culvert 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: u4' • PERMIT FEE $ .2-5 — 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$ Date !nit 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:,E c�� � , S 40, LI) 5 N . 1105 V(Si4 20ACt 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 - i proposed development(If yes, go to signature block; If no, go to 2a) $Y=- ❑ 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: 51.-LY C.IRIVAUVEN1 Piimt4tu�llL J��NSP Print Nam= Title 5.ZO Sign=Tha 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. drde one Spokane County Representative Date CITY OF SPOKANE VALLEY Cert of Sewer Availability.doc 01/09/02 C • O co O 5'CHAMPS 1•- . Y_ Ii') W I RETAPwa 19AUSHRUBS p(4'WOE 9 a'MRI) O SIRUCHNIE 9444:(4'MDC \� 86' 7 "1'1%13, SHOP c QIAINII� 4' ' MU" I ' ! Z O CO 6565' 6 105' w ;. I —� /101 17 (07 44' 1465- • 1.;; I , r cz oI ( L.V I o SHOP C 1� 45,513 S.F. CO •c4„IEEE 2.0709c O) Q 6,882 S.F. r 1 o 5 v- 4 10' UTILI .S' 3 EASEMEN 10,003 S.F. 9,889 S.F. - 9,791 S.F. e1--- 1a5' I!1 ili ' I. •NN � �� •--� t� T— L-1-I t_ .n i n CO›.in DI 12 0 ,-- dilliallei v el -� .,ter,. \ •I DI 1 11 12 PBX • v !' a PPP nn9w ON J PE rCH "W 'RIAINLIN Agortie.L ++� 4'CHPAI INKPUN it 014761EAC MSS , ;• I MERCK TO n 4'G+ARRP*4--' II li PROP. APPROVED B 4 ...if 40 NORTH SCALE: 1"= 4E1' Ct.0 ASSOCIATES SU �` 707 WEPT TTN AVENUE \ 'K_ SUITE POD ROYAL V L WAP 09 aTON 90704 IgO ■!D9 4Pa 01940 O F 309 41919 is 44 G RcNITE 0.DON CA AECOINO PLANNING TURE CND�NEEAE NR CHIP "^ Lw NDileApE L ND PUPVEYINO YAC `a''9 D5/D6/03