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2004, 11-19 Permit App: BLD-04-08144 Remodel'SOlan e jValley. 4\ka 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: