2004, 11-19 Permit App: BLD-04-08144 Remodel'SOlan
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206...
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: oC 7oz/ /1) (,o L.:id /a/ E C/�
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
. # UII,DIEG.PERMIT ... UCHANGE.IN.USE QGRADING
QRELOCATION• EISIGN }TENANT
D MAPiUFACTuRED HOME
ElOtatt.
OWNER / APPLICANT INFORMATION
OWNER:Nfi--Ci7 iYtav//a SdkP
RHONE:'09 - 89/ -/.St FAX:
APPLICANT:1 Q /J a 0: a co J'"%l
PHONE: roS - Ar9/ -/) ?d FAX:
ADDRESS: 9702/ /v (1)A;Ti� /P C76 Siookos,tDDRESS:c %a//V LU(.i//C Std/cy,e
CITY,STATE, ZIP . P CITY, STATE, ZIP
CONTRACTOR:
PHONE:
FAX:
ADDRESS:
CITY,. STATE, ZIP
WA ST CONTRACTOR LICENSE #
ARCHITECT:
PHONE: FAX:
ADDRESS*
CITY, STATE, ZIP
CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
BUILDING HEIGHT TO PEAK:
BUILDING DIMENSIONS:
NUMBER OF STORIES:
NUMBER of BEDROOMS:
FLANKING SETBACK:
FRONT SETBACK:
REAR SETBACK:
LEFT SETBACK:
30% SLOPES ON PROPERTY:
OCCUPANCY GROUP:.
CONSTRUCTION TYPE:
STRUCTURES ON PROPERTY:
CRITICAL AREAS:
CURRENT PROPERTY SIZE:
CURRENT PROPERTY USE:
CURRENT SEPTIC USE:
CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MAIN FLOOR SQ FT:
2N0 FLOOR SQ FT:
UNFIN BASEMENT:
FINISHED BASEMENT:
GARAGE:
COVERED DECK:
DECK:
1
MANUFACTURED HOME SIGN
WIDTH: LENGTH:
YEAR: PIT SET:
MANUFACTURER:
SQ FT OF SIGN: HEIGHT OF SIGN:
# OF SIGNS: AREA OF EXIST SIGN:
TYPE OF SIGN:
1
RELOCATION
FIRE SAFETY
1
PREVIOUS ADDRESS:
PROPOSED USE:
FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT;
FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER:
ADDRESS:.
PHONE: FAX:
CITY, STATE, ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY, STATE, ZIP
SPECIAL INSPECTIONS
❑ BOLTING
FIRM NAME:
INSPECTOR(S):
CICONCRETE
REINFORCEMENT
PHONE:
WELDING
FAX:
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 13 YES 0 NO
El
IS PUBLIC WATER AVAILABLE: ® YES NO IF YES, WHICH WATER DIST/IRR:
IF YES: CI COUNTY
❑ CITY
IS PROPERTY LOCATEDINITHIN DESIGNATED STORMWATER CONTROL AREA: CI YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ❑ NO PSSA: 0 YES 0 NO
[DATE:
METHOD OF PAYMENT:
STAFF:
0
CASH CHECK
CIZ
BANKCARD 41; EXPIRES: VIN#
AUTHORIZED SIGNATURE. -
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
MECHANICAL PERMIT APPLICATION Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: tr) % a-/ /0 • W :r/ /c Cf
Owner T nei4)0 //'ria rOPJ/rt �n�n
Mail ng Ad&r€ss a 7 a-/ /LI r n 4 +rA e -e
Con rector: License #:
Mail ng Address:
Permit Use:
Phone (Daytime Contact): go 9 - R5/ -i
City
State
Phone #:
Zip Code
tat
Zm Code
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
# OF UNITS
X
COST
=
TOTAL AMOUNT
1
FUEL BURNING APPLIANCE
Equal to or less than 100,000
X
$12.00
=
2
FUEL BURNING APPLIANCE
More than 100,000
X
315.00
=
3
UNLISTED APPLIANCE (Additional Fee)
Equal to or less than 400,000
X
350.00
=
4
UNLISTED APPLIANCE (Additional Fee)
More than 400,000
X
3100.00
=
5
USED APPLIANCE (WSEC min. AFUE rating)
Equat to or less than 400,000 &
X
350.00
=
6
USED APPLIANCE (WSEC min. AFUE rating)
More than 400,000
X
3100.00
=
7
BOILER/REFRIGERATION
1 - 100M BTU
X
512.00
=
8
BOILER/REFRIGERATION
101 - 500M BTU
X
520.00
=
9
BOILER/REFRIGERATION
501 - 1,000M BTU
X
525.00
=
10
BOILER/REFRIGERATION
1,001 - 1,750M BTU
X
535.00
=
11
BOILER/REFRIGERATION
More than 1,750M BTU
X
560.00
=
12
GAS LOG, GAS INSERT GAS FIREPLACE
X
310.00
13
RANGE
X
510.00
=
14
DRYER
X
510.00
=
15
FUEL BURNING WATER HEATER
X
310.00
=
16
MISC. FUEL BURNING APPLIANCE
X
510.00
=
17
GAS PIPING (each outlet)
X
51.00
=
18
DUCT SYSTEMS
X
510.00
=
19
VENTILATING FANS
t=
X
310.00
r
I Q i
20
AIR HANDLER (DOES NOT include ducting)
Equal to or less than 10,000 CFM
X
512.00
=
21
AIR HANDLER (DOES NOT include ducting)
Greater than 10,000 CFM
X
315.00
=
22
EVAPORATIVE COOLERS
X
310.00
=
23
TYPE I HOOD
X
550.00
=
24
TYPE 11 HOOD
X
$10.00
=
25
HEAT PUMP/AIR CONDITIONER
0-3 TON
X
512.00
=
26
AIR CONDITIONER
3-15 TON
X
520.00
=
27
AIR CONDITIONER
15-30 TON
X
525.00
28
AIR CONDITIONER
30-50 TON
X
335.00
=
29
AIR CONDITIONER
More than 50 TON
X
560.00
=
30
LPG STORAGE TANK
X
$10.00
=
31
WOOD OR PELLET STOVE/INSERT
X
310.00
=
32
WOOD STOVE - FREE STANDING
X
325.00
=
33
REPAIR & ADDmONS
X
515.00
=
34
VENTILATION SYSTEMS
X
512.00
=
35
VENTILATOR MECHANICAL EXHAUST
X
512.00
=
36
INCINERATOR - RESIDENCE
X
519.00
37
INCINERATOR -COMMERCIAL
X
522.00
-
METHOD OF PAYMENT:
0 CASH 0 CHECK 0 VISA 0 MC
rnan s-
DATE:
SUBTOTAL
PROCESSING FEE
535.00
EXPIRES:
TOTAL PERMIT FEE DUE:
Et'i
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATIE t
Phone: (509) 688-0036; FAX: (509) 688-0037
For Inspections, Call (509) 688-0054
Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Project Address: 9 7rA/ N wh pf/P a'/- Permit Use:
Phone (Daytime Contact): c -o9 RS/ -/ 5'3 a
Owner 75r,a-eAa / a,rrPiA 4.$,11/[)
Mailing Address: (9 i1) ua h ri1"r/e c,e
City
State Zip Code
Contractor: License #:
Mailing Address:
Phone #:
City
State
Zip Code
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
DESCRIPTION OF WORK
R OF
UNITS
X
COST
=
TOTAL AMOUNT
1
TOILETS
WATER CLOSET, BIDETS
'
X
$6.00
=
//���
Ly —D0
2
URINALS
X
36.00
=
3
TUBS
'
X
$6.00
=
(/ 9 a
4
SHOWERS (PER TRAP)
BATH, STALL, ONSfTE BUILT
X
56.00
=
5
SINKS
LAVSBASINS, BAR, FLOOR, KITCHEN,
LAUNDRY, UTILITY, JANITOR, PHOTO,
X-RAY, FOOD, PREP/CULINARY MEAT
`�,
X
$6.00
=
I �D d
6
DISHWASHER
X
$6.00
=
7
CLOTHES WASHER
X
36.00
=
8
GARBAGE DISPOSAL
X
$6.00
=
9
WATER SOFTENER
X
$6.00
=
10
ELECTRIC HOT WATER TANK
NOTE: IF GAS, SEE MECHANICAL
X
36.00
=
11
FLOOR DRAINS
AREA. CASE, COIL, TRENCH, CONDENSATE
X
$6.00
=
12
ROOF DRAINS/OVERFLOW
DRAINS
X
56.00
=
13
FOUNTAINS, DRINKING
X
36.00
=
14
WATER PIPING/DRAIN-IN WASTE,
VENT PLUMBING, REVERSAL
NSTALLATION, ALTERATION, REPAIR,
REVERSALS
X
$6.00
=
15
SEWAGE EJECTOR
GRINDER, SUMP PUMP
I
X
36.00
=
po
16
WATER USING DEVICE
ICE AN/OR COFFEE MAKER, HOSE BIB,
STEAMER
PROOFER, CARBONATOR, SWAMP COOLER
X
56.00
=
17
CROSS CONNECTION DEVICE
VACUUM BREAKER, CHECK VALVE,
ANb R.P.B.P.D. FOR: VATS, TANKS, BOILERS
X
56.00
=
18
INTERCEPTORS
GREASE TRAP, SAND TRAP,
CHEMICAL HOLDING TANK
X
36.00
=
19
MEDICAL GAS (per outlet)
NFTROUS, OXYGEN
X
$6.00
=
20
MISCELLANEOUS PLUMBING
FIXTURE
X
$6.00
=
21
PRIVATE SEWAGE DISPOSAL/SYS
X
520.00
22
INDUSTRIAL WASTE
INTERCEPTOR
X
315.00
=
METHOD OF PAYMENT:
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD
DATE: EXPIRES:
SUBTOTAL
PROCESSING FEE
335.00
M
TOTAL PERR FEE DUE:
/ T Q
-
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: