2003, 06-20 Permit App: BD03-688 Residence •
iECENVED
JUN 2 3 2003
City of [3 .
(9��. 003(PSPOKANE VALLEY IL [ 0 Fav
PERMIT a Da 3 -/,grr •�
BUILDING PERMIT APPLICATION
Box-1 OWNER ` \
l� JOB LOCATION
OWNER'S ADDRESS CITY PHONE \'. \t"›\ S �� ��\�
DESCRIBE JOB �F
•THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
•
PARTNERSHIP CORP. .,/
BOX 2 CONTRACTOR'S NAME \��c-c-\ CPHONE
CONTRACTOR'S ADDRESS .« 5c CITY
CONTRACTOR'S REG.# �� ��� � �1�OC� EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VEF IFIED)
BOX 3 CONTACT PERSON OF PROJECT C� s �,,� PHONE
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY
4� � WATER AVAILABILITY
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG.VALUATION$
BOX 6 PROPERTY TAX ACCOUNT NUMBER
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
• CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR \\13 / 2ND FLOOR /
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGECI\4&K /
CA7RPORT / TOTAL / • HEIGHT TO PEAK OF BUILDING FT.
•
30X8 ( V) SINGLE FAMILY ( \4 NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) - ( ) EXISTING STRUCTURE
( ). COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY \\44\ SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ \cpm !I SQ. FT. •
3OX 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--- if
OX 10 Wu ter Service meter size (if known) 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.
✓VNER/AGENT \
111L'rCbr
y 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 WRITE BELOW THIS LINE
ZONE__ SETBACKS: FRONT
SIDE REAR HEIGHT LIMIT
PLANNI,\IC DEPARTMENT APPROVAL
DISAPPROVAL DATE
REMA KS — —_
SEPA: E=X-MPT .: NOT EXEMPT
FIRE 0 ri)A^.,,RTMENt '
i PPROVAL
DISAPPROVAL
RE1.IA F.' r_-', DATE
PUP 00 ';r,'CRKS DEPARTMENT APPROVAL
DISAPPROVAL DATE
TYPE C ,!C3: NEW RESIDENCE RES,ADD/ALT
NEW INDUSTRIAL IND.ADD/ALT
NEW CC:,1M_ERCIAL COMM.ALT/ADD
NEW MULTIFAMILY NO. UNITS
MULTIFA i;I L Y ADD/ALT
TENANT IMP. ROOF OTHER
OCCL;PA Y TYPE OF CONSTRUCTION TORIES
�=
BUILDING SQ. FT. L/ b @ 6 �� om
�'C J
iirJfrilielit-______,413UILDING z SQ. FT. @ -i-rfrit
r
3 4—__BUILDING SQ. FT.4@ -
— _BUILDING SQ. FT. / @ 7/(9�° ,
�7 �7
TOTAL SQ. FT. TOTAL VALUATION. fr �-
175-
BUILD!. '" =i:MIT NO. O3-6g'g' PLAN CHECK FEE REC'D
RECEIPT NUMBER
PERM! ;_ PLAN CHECK FEE�e Sj PLUMBING FEE �� co
_g �P MECH. FEE
TOTAL I= S 1/ rWSBCC SURCHARGE ENER
• GY SURCHARGE
OTHER CI;:,,'ZGES 1
AMOUNT DUE
BUILDING L ,_'PARTMNT APPROVAL BY
DATE
ASSIGNED ADDRESS /3/`
Ataryee...1
ill
OT 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
�e ik
Spokane Valley,WA 99206 509-688-0037-Fax
40.00Valley For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT PERMIT
ADDRESS: \'' \\ S .�� \z USE:
OWNER: e PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
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 -
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 101-500M BTU 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 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 - Ar X $10 -
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 -
21 AIR HANDLER(DOES NOT indude ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/ATR CONDITIONER 0-3 TON 1 X $12 -
26 AIR CONDITIONER 3.15 TON 't X $20 -
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:
If 7do
METHOD OF PAYMENT PLUS PROCESSING FEE: ...S35:00----
rie14,, TOTAL PERMIT FEE DUE 1 xy
0 CASH 0 CHECK ❑ =WM 0 ' .= `:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTNne?7T )cl(N-1T' 7'-
on' 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
PORane Spokane Valley,WA 992D6 509-688-0037-Fax
,000Valley For Inspections, call 509-688-0054
Plumbing Permit Application M7o - 6 fl
PROJECT PERMIT
ADDRESS: \ \� \ " '� �'@\°' USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (LIP) •
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- 4 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:VATS,TANKS,BOILERS X
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
4ETHOD OF PAYMENT SUBTOTAL:PLUS PROCESSING FEE: �/�
�r:z� '
Vim.
] CASH • VISA lk"z5 .; /
0 CHECK 0 V
TOTAL PERMIT FEE DUE: 9/,' '''',
?ATE: EXPIRES:
ANKCARD NUMBER:
UTHORIZED SIGNATURE:
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