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2003, 05-16 Permit App: BD03-454 Residence City of 6vW- 003(P SPOKANE VALLEY )( Cr,n,•U037 PERMIT # BUILDING PERMIT APPLICATION Box-1 OWNER \--\\o��� � � � JOB LOCATION OWNER'S ADDRESS\ CITY � �,. PHONE QRZ �� \� O°tIS°c DESCRIBE JOB THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP. f BOX 2 CONTRACTOR'S NAME PHONE CONTRACTOR'S ADDRESS CITY CONTRACTOR'S REG.# o\o'\ EXPIRATION DATE . (CARD MUST BE PRESENTED AND COPIED OR VEF IFIED) BOX 3 CONTACT PERSON OF PROJECT C\--, 5.�.p.r� PHONE ADDRESS CITY ZIP • BOX 4 SEWER AVAILABILITY � � WATER AVAILABILITY BOX 5 ESTIMATED PROJECT COST$ `‘'S ��� EXISTING BLDG.VALUATION $ BOX 6 PROPERTY TAX ACCOUNT NUMBER LEGAL DESCRIPTION \c4, I. (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 / \SIV 2ND FLOOR / 3RD FLOOR / OTHER / BASEMENT FINISHED / I% BASEMENT UNFINISHED / N DECK / \ GARAGE / CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING \t FT. 30X 8 ( 4) SINGLE FAMILY ( ) MULTIFAMILY(NO. OF UNITS ( � NEW CONSTRUCTION ( ) COMMERCIAL/ INDUSTRIAL ) � ( ) EXISTING STRUCTURE ( ) COMM TENANT IMPROVEMENT • TOTAL AREA OF PROPERTY `C'c 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. 11 OX 10 Water Service meter size (if known) \ `y 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) nATr: S- 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 NOT T WRITE ------------- --------------- BELOW THIS LINE =============================================================== ===========================SETBACKS: FRONT --------------------------------------- SIDE REAR .__HEIGHT LIMIT PLANNING DEPARTMENT APPROVAL DISAPPROVAL REMARKS DATE SEPA: EXEMPT . NOT EXEMPT — ----------------- FIRE D`TARTMENIIAPPROVAL DISAPPROVAL REMARKS DATE PUBLIC WORKS DEPARTMENT APPROVAL ======================================= — — — — — DISAPPROVAL DATE TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL INp.ADD/ALT NEW CO.' ,MERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS MULTIFAMILY ADD/ALT --- TENANT IMP. ROOF --.__OTHER OCCUPANCY TYPE OF CONSTRUCTION STORIES 1 BUILDING SQ. FT. @ BUILDING SQ. FT. @ --__BUILDING SQ. FT. @ BUILDING SQ. FT. @ TOTAL SQ. FT. TOTAL VALUATION BUILDiNG PERMIT N0. PLAN CHECK FEE RECD RECEIPT NUMBER PERMI i- FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE • ENERGY SURCHARGE OTHER CH;',!-GES I AMOUNT DUE BUILDING DEPARTMENT APPROVAL • • BY DATE ASSIGNED ADDRESS I 3 c( �. �•� � - /03?-3?2D '34 36.- ��'t2-Z8`OG 1S-�c�� 71,i0-10-0° 2`45.'1� • �7 e Flo. SaTlt 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone pokane Spokane Valley, WA 99206 509-688-0037-Fax For Inspections, call 509-688-0054 ��Valley 'Mechanical Permit Application PROJECT PERMIT ADDRESS: USE: OWNER PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) CONTRACTOR: (� r \ LICENSE It: 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 - i 5 2 FUEL BURNING APPLIANCE >100,000 X $19 - 3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000 X g50 - 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 101-500MBTU 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 RANCE - X $10 - 14 DRYER - I X $10 - )'c) 15 FUEL BURNING WATER HEATER - li X $10 - 10 16 MISC.FUEL BURNING APPL. - X $10 - 17 CAS PIPING(ea.Outlet) - X $1 - JS 18 DUCT SYSTEMS - X $10 • 19 VENTILATING FANS - X $10 - LP 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 510 - 23 TYPE I HOOD - X $50 - 24 TYPE II HOOD - X $10 - 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 - 26 AIR CONDITIONER 3-I5TON , X $20 - 2') 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: r* METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00 VISA' rJ'aslsr ar{ TOTAL PERMIT FEE DUE: ❑ CASH ❑ CHECK D EMMA ❑ •.—_:,_-__`' - DATE: EXPIRES: BANKCARD NUMBER: AU11-TnP_IZF.n SI(;NAT .r.- S<- e�r�� 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone 1 ��pokane Spokane Valley,WA 99206 509-688-0037-Fax 4000 Valle For Inspections, call 509-688-0054 I , Plumbing Permit Application PROJECT PERMIT ADDRESS: vs�� c �\ c e`' USE: . OWNER: `)�' \0`c�\k �C ‘c PHONE(Daytime Contact): ..t., ,\.\1..c. pt s,,c MAILING ADDRESS: c \ ''\'-)— tc c Ii-- k •\01--c. <.il_- \K . \t)\Th c�K (street) (city/state) (ZIP) CONTRACTOR\ \X. S \ LICENSE#: MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) ' PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS X $6 2 URINALS X $6 - 3 TUBS 1- X $6 - 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT \ X $6 - 5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, • LAUNDRY,UTILITY,JANITOR,PHOTO,X- X '$6 - RAY,FOOD,PREP/CULINARY/MEAT 6 DISHWASHER \ X $6 - 7 CLOTHES WASHER X $6 - 8 GARBAGE DISPOSAL X $6 - 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 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR:VMS,TANKS,BOILERS X $6 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X HOLDING TANK - 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 - 20 MISC.PLUMBING FIXTURE X $6 SUBTOTAL: I 4ETHOD OF PAYMENT (' j - ' • VISA' liras'AK! . PLUS PROCESSING FEE: $35.00 T.- J CASH 0 CHECK 0 0 __._._ _' TOTAL PERMIT FEE DUE: LATE: EXPIRES: ANKCARD NUMBER: UTHORIZED SIGNATURE: Call 24 hours before inspection required ci Phone 509.688-0036 Fax 509.688-0037 Sökane 400100Valley DEPARTMENT OF PUBLIC WORKS Anticipated start date Permit # PW O 3_zz APPROACH PERMIT APPLICATION Location of property \ \Q, (Address/Parcel #, if available) Applicant Name \--\\�y.4-„:1,ata,�a, Com\• Address cc Phone S \.`>._.. \C Contractor's Name �c�•crQ. Address Phone Contractor's Reg# Expires PROJECT DESCRIPTION (Provide site sketch) IV-1 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: PERMIT FEE $ 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$ �_5r Date Sy/Co Init h • /, ____. ,_6/1,,-. i . gl tv L___.• 1. . �v, 1 ,w ,___ , r' 7 ,.. , 1 _ _ . i . 2—. , _ \...„......-67 , . , . . , L _ I \_ lia,„ , ,\\..c_. . \h C • 1 . I , g .. / --...,,k. _ , APPROVED BY •k........ l ifsiLi. "33 04-f