2003, 12-02 Permit App: BLD-03-03176 Residence •
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING D/V/S/ON
77707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: 509 688.0036 Fax: 509 688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS:_ /I' U ,i /1/ V L >tom( --- -
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:_
gitifILDING PERmrr • a CHANGE xN USE • CIGRADING MANYTFACTVRED HOME
DRELOCATION DSIGN CITENANT 13-0
Lias
OWNER /APPLICANT INFORMATION j
® OWNER: ® APPLICANT:
PHONE: - FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP • CITY,STATE,ZIP
CONTRACTOR: D. ARCHITECT: -
PHONE fS( • q2q• p (04 FAX:,x- . '"1 . SOC14 PHONE: FAX: -
ADDRESS:`?./5321 E .19'I+55, OY) V Pr'4CIQ�-� WI) ADDRESS:
CCITY.,STATE 4 37 Cf7Y,STATE,ZIP
WA ST CONTRACTOR LICENSE it X OrA��1IOIQLT O3j 0!1 CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 6C F- 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: fI CI 61
BUILDING HEIGHT TO PEAK: y CfCCUPANCY GROUP: 2ND FLOOR SQ FT;
BUILDING DIMENSIONS: f'V T)$1 Z- CONSTRUCTION TYPE: C.6',r J- UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY; FINISHED BASEMENT;_ _
NUMBER of BEDROOMS: 3 CRITICAL,AREAS: -- GARAGE: 36,
C -
DATE: STAFF: _ -- �_.... -
METHOD OFPA PAYMENT:
0 rr r d immimar
Mem
CASH CHECK L
BANKO4RD 0; EXPIRES: V/N#
AUTHORIZED SIGNATURE:
S0/20'd P6089E6 01 dd TO:Li 200E OE d9S
R
• r 11707 East Sprague Avenue,$
uite 106 509-688-0036 Phone�e Spokane Valley,WA 99206 509-688-0037-Fax
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Plumbing Permit Application
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PROJECTPERIvII I
ADDRESS: 'y �i u / P' v ' S+`1 USTs
OWNER: �— PHONE(Daytime Contact):
MAILING ADDRESS:
15 32_1 E. , ri'- SS an y,ero (IcLe...,.WA ggC)37
(street) (city/state) (ZIP)
NTRtACT'OR 5,9,a o l koLk— (it15"i" UCENSE8: �.LA in
C CO3w
MAILING ADDRESS:
PHONE r: _ 1 �2±-1-.
(street) (city/state) Rm. •
PLUMBING FDGCURES
DESCRIPTION DETAILS •OF UNITS X COST EQUALS AMOUNT
TOILETS ILEIS WATER CLOSET,BIDE Z. XS6 6711-
2 URINALS ___, X $6
3 TUBS `— •_ X $6 -
4 SHOWERS(PER TRAP) BATH,STALL„ON-51TE BUILT 2_ x §6 t t-1-
5
5 SINKS (A VS/BASINS,BAR,FLOOR,KITCHEN,
' LAUNDRY,UTILITY,Y,JANITOR PHO'T'O,X- 3 X " • u -
RAY,FOOD:PREP/CULINARY/MEAT /
6 DISHWASHER i X $6 (C
7 CLOTHES WASHER X $6 - 0
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B GARBAGE DISPOSAL X 1 $6 -
9 WATER SOFTENER X 56
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 -
11 FLOOR GRAINS AREA,CASE;COIL,TRENQH,CONDENSATE X $6 ' -
12 FOUNTAINS,DRINKING ' X Sb -
33 WATER MING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, -
WASTE VENT,PLUMBING REVERSALS. X 55
REVERSAL •
14 SEWAGE ELECTOR GRINDER,SUMP PUMP X $6 —
-
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER.HOSE BIB,
STEAMER,PROOPER,CARBONATORZ, X $6 - -
SWAMP COOLER 2 !Z
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR VATS,TANKS,BOILERS X -
17 SPRINKLER SYSTEM X $2
-
Is INTERCEPTORS GREASE TRAP.SAND TRAP,CHEMICAL •
HOLDING TANK X Iib -
19 MEDICAL GAS per outlet NITROUS,OXYGEN -X 1 $6
20 MIST PLUMBING FIXTURE .--_, --- X 56 -
HOD OF PAYMENT SUBTOTAL: 60
AID
PLUS PROCESSING FEE: 535.00
'LSH 0 CHECK 0 NM. ❑
TOTAL PERMIT FEE DUE: /0
EXPIRES:
GIRD NUMBER:
ORIZED SIGNATURE;
SO/PO'd 176089E6 01 eld TO:LT 200Z 0Z d3S
** S0.30dd 14101 **
Spodea1�' 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Spokane Valley,WA 99206 509-688-0037-Fax
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Mechanical Permit Application
PROJECT �— PERMIT -"—'_
ADDRESS: I/O 7 N. Vi 5.4-43 UTSE: •
OWNER PHONE(Daytime Contact)
MAILING ADDRESS:
/532 I 55, (NI V eracLa l 2_ uJii) GR 037
(street) (city/state) (ZIP)
CONTRACTOR: ,�r,,.)v-,�� 12v�.��a,'►5t , LIC�N5E�: •
MAILING ADDRESS �� /yA /m� sc Qq2(�C
PHONE I: J /`. / q 2_ / b9-
(street) •(city/state) (
DESCRIFa0N OF WORK I OF ta,IltS) % COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE .-OR a 100,000 1 /I X ' us —
2 FUEL BURNING APPLIANCE >100,000 �' �-
3 UNLSrED APPuANCE(ADDrrIONAL YER) -OR e X • $Lo
�— 400,000 -- X S50 -
4 UN ISTED APPLIANCE(ADDITIONAL PEE) ,00,0133 — X . $100
5 USED APPLIANCE(MEC nun.AFUE Ming) ,or<40a000 _�_� - ��-•
6 USED APPLIANCE(W ECC min.AFUE ng) s 400,000 X 5100 ••
7 BOILEIVREFRIGERATION 1-10014 BTU .._,,_ —_—__....___"_X 515
g BOII.FWREFRIGERATION _ 101-S00MBTU -- X 32d
9 60/LER/REFRIGERATIONSBI_LOOM BTU X Syg
10� 1001•L750M 6!U X $37
11 BOILER/REiRIGERATrON +1750M BTU -- X i55
12 GAS LOC,GAS INSERT,GAS FLREPLACE - X -
13 RANGE X $10
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14 DRYER . - X $10
•
is FUEL BURNING WATER HEATERj X —$10 ` .,
16 MLSC FUEL BURNING APDL. - — X 520 -
17 GAS P1P1NC(ea.Out407 -
7a DUCTSYSCEMS - Z X it - �-
_ - x _no
39 VENTILATING FANS X AO
20 AIR HANDLER(moss NOT Mudd dueling) .13 c 10,000(�M TX 112 - `/
21 AIR HANDLER(D065 NOT Include chiding) )14,o00 c3,14 •— X l 519 .
Zl EVAPORATIVE COOLERS - X 510 0
21 TOE I HOOD - X $50 •
24 TYPE if HOOD X 510 • 1 Li
25 NEAT PUMNAIRCONDIITONER 0-3 TON X $12
26 AIR CONDITIONER 3-IS TON — X 519
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2i AIRCOM:9'110 MR IS-SOTON -_ X S25 ,
28 AIR CONDITIONER 30-50 TON X 539
.
2sAIR CONDITIONER 450 TON — X S60 -
30 LPG sIORAGOTANK - -- X 810 -
31 WOOD OR PELLET SfOVFj N5Mr7 - X ' $10 -
32•WOOD STOVE•FREESTANDBYG - X S23 ■
SUBTOTAL l 7
METHOD OP PAYMTI PLUS PROCESSING FEE $35-00
••,;:.:•,,...•:,".„-W. TOTAL PERMIT FEE DUE: /U.Z.
d CASH ❑ CHCCK p 1.111111 p
DATE; _ EXPIRES:
BANICCARD NUMBS
AUTHORIMID SIGNATURE:
S@!S@ d 176089E6 01 dJ TO:LT £00E OE d3S
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DATE: 16