2003, 06-24 Permit App: BD03-686 Residence EECEir En
City o f I
Phone 688-0036
SPOKANE VALLEY JUN 2 3 2003 FAX 688-0037
D3U Q � D H M Inspection 688-0054
PERMIT # aD 03 -ha
BUILDING PERMIT APPLICATION
Box 1 OWNER JOB LOCATION 7/), 4. tiln,ejp. GT
OWNER'S ADDRESS CITY ST. PHONE
DESCRIBE JOB (/fflt fitA/V PeS/, tL
A
11 rm�k _ , At ETis
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED PARTNERSHIP CORP.
BOX 2 CONTRACTORS NAME pte,n-(> (i / 5r l/Ve- PHONE 5 3s-ern ("I/lark)
CONTRACTORS ADDRESS 31z4 S . Yeecc 1 *41'6 CITY 4P. e—
CONTRACTOR'S REG.# PIRA) Cf /64 g5 EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT PHONE
ADDRESS CITY ZIP
BOX 4 SEWER AVAILABILITY ( rery WATER AVAILABILITY "Pr",
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 / 6G 2ND FLOOR
3RD FLOOR / OTHER / BASEMENT FINISHED /
BASEMENT UNFINISHED / DECK / GARAGE / 8e2
CARPORT / TOTAL / mg HEIGHT TO PEAK OF BUILDING FT.
BOX 8 (/r) SINGLE FAMILY ( ") NEW CONSTRUCTION
( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE
( ) COMMERCIAL/ INDUSTRIAL TOTAL AREA OF PROPERTY // ?0,z, SQ. FT.
( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE_ SQ. FT.
BOX 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.
BOX 10 Water Service meter size(if known) Also see BOX 4
BOX 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)
BOX 12 Street use may require a" Street Use Permit" for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
OWNER/AGENT DATE (OVER)
s-vappbp 4-16-03
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card:
Visa MastercardExpiration__ ____ ____ ____ Expiration Date
Print the name of the Holder Signature
DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES.
OFFICE USE ONLY- PLEASE DO NOT WRITE BELOW THIS LINE
ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT
PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
SEPA: EXEMPT NOT EXEMPT
FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE
TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND.ADD/ALT
NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER
OCCUPA Y TYPE OF CONSTRUCTION STOIES
BUILDING SQ. FT. (7 2-I @ 67 _ // l 2-11
6ras-a-rese-- BUILDING SQ. FT. I74 @ / = 7( �p .....
BUILDING SQ. FT. @ _
BUILDING SQ. FT. @ =
TOTAL SQ. FT. TOTAL VALUATION ( 2-4 47//J
BUILDING PERMIT NO.03 ` 6 836 PLAN CHECK FEE REC'D RECEIPT NUMBER
3J 57 o0
•PERMIT FEE 3 PLAN CHECK FEE 247 PLUMBING FEE 0 �' MECH. FEE ( 1 0.--
?'. Io
TOTAL FEES /4 73 WSBCC SURCHARGE - ENERGY SURCHARGE
OTHER CHARGES AMOUNT DUE ",.',.
BUILDING DEPARTMENT APPROVAL BY
DATE
ASSIGNED ADDRESS
Received
(�art cx 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
IJpote Spokane Valley,WA 99206 509-688-0037-Fax
4000Val ley For Inspections, call 509-688-0054
Plumbing Permit Application 4-Doi3 -- ba
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: �70/A ty_,. �r'/ (GLt�_) . LICENSE#:
MAILING ADDRESS: IEPHONE#:
(street) (city/state) (LU') •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS E X $6 - .l6
2 URINALS X $6 -
3 TUBS X $6 - 6
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 1
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, ,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X . $6 - 24
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 - tj
7 CLOTHES WASHER X $6 - ,6
8 GARBAGE DISPOSAL X $6 - 1(
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 X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6
SUBTOTAL:
IETHOD OF PAYMENTMOM (J •
C
•Il PLUS PROCESSING FEE: $35.00
as
] CASH 0 CHECK 0 EMiiii 0 I_. :: ': .
TOTAL PERMIT FEE DUE:
ATE: EXPIRES:
NNKCARD NUMBER:
UTHORIZED SIGNATURE:
stlTYt 01111111111"1\11%11114, 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
kane Spokane Valley,WA 99206 509-688-0037-Fax
Palley For Inspections, call 509-688-0054
JMechanical Permit Application 0 3) 0 34009
PROJECT PERMIT
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) �p (city/state) (Zn')
(
CONTRACTOR: k�/
4/e.- ry LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 ( X $15 -
/2-
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 -
$ 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 - /0
13 RANGE -
14 DRYER / X $10 ., 20
- / X $10 - 00
15 FUEL BURNING WATER HEATER - / X $10 - /t7
16 MISC.FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - X $1 - 3
18 DUCT SYSTEMS -
X $10 -
19 VENTILATING FANS - r X $10 -
20 AIR HANDLER(DOES NOT include ducting) -OR<10,000CFM X $12 -
21 MR HANDLER(DOES NOT include 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/AIR CONDITIONER 0-3 TON X $12 -
26 AIR CONDITIONER 3-15 TON X $20 -
27 AIR CONDITIONER 15.30 TON X S25 =
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:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00 t ' (/04,
MINIM -i1 5 a ,, TOTAL PERMIT FEE DUE:
0 CHECK 0 =�.�y'
0 CASH0 '__. ..:'.:w��_
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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