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2003, 11-11 Permit App: BLD-03-03061 Residence City of (9w-o03(o SPOKANE VALLEY X Cn i- 0037 PERMIT # BUILDING PERMIT APPLICATION Box l OWNER � �_.J Cz:): 'c JOB LOCATION OWNER'S ADDRESS CITY PHONE S DESCRIBE JOB • THIS PROPERTY IS OWNED BY: SINGLE/MARRIED °'ARTNERSHIP CORP. BOX 2 :CONTRACTOR'S NAME �—_�'--------- PHONE CONTRACTOR'S ADDRESS CITY CONTRACTOR'S REG.# \ �,toG; � �. �, EXPIRATION DATE I • (CARD MUST BE PRESENTED AND COPIED OR VE IFIED) BOX 3 CONTACT PERSON OF PROJECT -� � `�---4�=� PHONE • ;DDRESS CITY ZIP • BOX 4 SEWER AVAILABILITY C 1 WATER AVAILABILITY —�--_ BOX 5 ESTIMATED PROJECT COST$ rev. \ EXISTING BLDG.VALUATION$ BOX 6 PROPERTY TAX ACCOUNT NUMBER • LEGAL DESCRIPTION • JF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) • CENSUS NUMBER f LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing I proposed) 1ST FLOOR / 2ND FLOOR / �D FLOOR / OTHER ' / BASEMENT FINISHED ! ASEMENT UNFINISHED / `_ DECK / `0 GARAGE /x,17 CARPORT / TOTAL / HEIGHT TO PEAK OF BUILDING ,�„ ' FT. 30X 8 ( J ) SINGLE FAMILY ,j --' ( ) MULTIFAMILY(NO. OF UNITS ( (NEW CONSTRUCTION ( ) COMMERCIAL/INDUSTRIAL ) ( ) EXISTING STRUCTURE ( ) TENANT IMPROVEMENT/IND ENT TOTAL AREA OF PROPERTY ��;Z.:'^ SQ. FT. • IMPERVIOUS SURFACE_ SQ. FT. • 3OX 9 1 _UMBING FIXTURES (Including rough-ins) • MECHANICAL APPLIANCESM 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 I Also 10 Water Service meter size(if known) _— {-----___ so 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. IERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRW AND • ORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE BOVE P TEMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE. NIv:ER .GENT � � DATE \ \- \\- �j; (OVER) I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: `'"'a Mastercard ---- Expiration Date P: . it the name of the Holder Signature OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT PL r,.NNING DEPARTMENT APPROVAL DISAPPROVAL DATE RI:MARKS SEPA: EXEMPT -- NOT EXEMPT 1 FIf' _ DEPARTMEN1UPPROVAL DISAPPROVAL '. DATE RE ,'ARKS • . • PUBLIC WORKS DEPRTMENTAPPROVAL DISAPPROVAL DATE_ TYI OF JOB: NEVI) kESIDENCE 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 — ,I BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ . BUILDING SQ. FT. @ _ BUILDING SQ. FT. • @ _ TOTAL SQ. FT. TOTAL VALUATION BUIL•`ING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER 1 PERMIT FEE PLAN CHECK FEE PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE • ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUIL' 'NG DEPARTMffNT APPROVAL . BY DATE ASSIGNED ADDRESS • . • r 1mv t 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone pokane Spokane Valley,WA 99206 509-688-0037-Fax Valley For Inspections, call 509-688-0054 Mechanical Permit Application PROJECT PERMIT ADDRESS: OWNER: h ` USE: \�\� PHONE(Daytime Contact): MAILING ADDRESS (street) (city/state) (ZIP) CONTRACTOR: (\ LICENSE#: 0A\:\,... , C;t•-.c,,„,c_cX MAILING ADDRESS: PHONE I: (street) (city/state) (ZIP) DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE •OR<100,000 \ X $15 - 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 101-500MBTU X $28 • 9 BOILER/REFRIGERATION 501-1,000M BTU X $39 - 10 BOILER/REFRIGERATION 1001-1,750M BTU X . 557 • 11 BOILER/REFRIGERATION +1750M BTU X 595 • 12 GAS LOG,GAS INSERT,GAS FIREPLACE - X $10 - 13 RANGE - % X $10 - 14 DRYER - X $10 - 15 FUEL BURNING WATER HEATER - \ X $10 • 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 CPM X $19 - 22 EVAPORATIVE COOLERS - X $10 • 23 TYPE I HOOD - X $50 - 24 TYPE II HOOD - X 510 • 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 AIRCONDITIONER 450 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 PLUS PROCESSITiG FEE: $35.00 1ET ;�ID OF PAYMENT __._...-.. i. ,.;',;--,F,.i TOTAL PERMIT FEE DUE: VISA ea.5f ❑ C.NSH ❑ CHECK ❑ =NM 0 =- D 7". EXPIRES: 3A.N kRD NUMBER: I `Mry -T ill 11707 East Sprague Avenue„Suite 106 r-10-TY 509-688-0036-Phone Spokane Valley,WA 99206 509-688-0037-Fax 41000Valley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT ADDRESS: PERMIT e _ .c c 4.1-0USE: OWNER: \-6%- r - PHONE(Daytime Contact): MAILING ADDRESS: S (street) ' C-.)\‘' - (city/state) (ZIP) CONTRACTOR: �._. c,\ c. c3,\ LICENSE#: MAILING ADDRESS: PHONE#: (street) (city/state) . PLUMBING FIXTURES DESCRIPTION DETAILS 1 TOILETS #OFUNTTS X COST EQUALS AMOUNT WATER CLOSET,BIDETSiminiminommX - 2 URINALS 3 TUBS - 4 SHOWERS(PER TRAP) BATH,STALL,ON-SfrE BUILT X $o 5 SINKS VS/BASINS,LABAR,FLOOR,KITCHEN, X S6MEM - EN, i LAUNDRY,UTILITY,JANITOR,PHOTO,X- '- RAY,FOOD,PREP/CULINARY/MEAT X u' 6 DISHWASHER ri CLOTHES WASHER IIIIIIIIIIIIIIIIIIIIIII.MIIIIIIIPIMIIX $6 .. - 8 GARBAGE DISPOSALOMIMMEMMINEMEMEIMMEMEIMMIIIIII X $6 ' 11111.11111 9 WATER SOFTENER X $6$ - - 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL - 11 FLOOR DRAINS AREA,CASE CH, COIL„TREN X $6 .• - CONDENSATE \ X $6 12 FOUNTAINS,DRINKING - 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, X - - WASTE,VENT,PLUMBING REVERSALS REVERSAL )( - 14 SEWAGE EJECTOR GRINDER,SUMP PUMP - 15 WATER USING DEVICE © $6 _ - ICE AND/OR COFFEE MAKER,HOSE BIB, S I LAMER,PROOFER,CARBONATOR, ' X SWAMP COOLER u' 16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND R.P.B.P.D.FOR VATS,TANKS,BOILERS X $6 7 SPRINKLER SYSTEMIIIIIIIIIIIIIIIIIIIIIIIIIIIIM .. _ 8 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X - HOLDING TANK X 19 MEDICAL GAS per outlet NITROUS,OXYGEN - X $6 - 20 MISC.PLUMBING FIXTURE X S6 • LETHOD OF PAYMENT SUBTOTAL: CASH ❑ ❑ ! _ .• � PLUS PROCESSING FEE: $35,00 I • TOTAL PERMIT FEE DUE: 'IM: EXPIRES: NKCARD 1,U IBER: ITHORIZED SIGNATURE: \cam Scs: APPROVED BY 0 l)J/2//7 0