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
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OFFICE USE ONLY-PLEASE DO NOT T WRITE -------------
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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
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APPROVED BY
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