2003, 10-14 Permit App: BLD-03-02779 Finish Basement somokanoge\i,a
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.000Valle1
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 906
Spokane Valley, WA 99206. ..
Phone:(509)688-0036 Fax. (509)688-0037
REQUIRED SITE INFORMATION I
STREET ADDRESS: Il 6 Z 1 Z A r"'t
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: F, yx ; '2,`n4i261,) nAQA -
BUILDING PERMIT Cl CHANGE IN USE I]GRADING CI MANUFACTURED HOME
®RELOCATION ®-SIGN 0-TENANT 0OTHER
OWNER / APPLICANT INFORMATION
fzi ' `y ✓1
OWNER: 'ems 1 ® APPLICANT: 3i7-/r1
c, , ` '7 X PHONE: FAX
PHONE: 3 1/Z- Ij�� / FAi
ADDRESS: i 1(3 Z/ z (1� L Y iZ 61- i1 ')''ADDRESS:
,,, LTY,$,6� k�TAT,ZJP 0 CITY,STATE,ZIP
0 ,T `7 CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: / g 0
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 3 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: iI 11%5\1 .2 iE')2 012VAJNFIN BASEMENT: c 6°
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
l
NUMBER of BEDROOMS: 2- CRITICAL AREAS: GARAGE: z1 0 o
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK: i"
FRONT SETBACK: CURRENT PROPERTY USE: DECK: F A Ci cry)
REAR SETBACK: CURRENT SEPTIC USE: vVA.::'
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OP SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
1 RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGYCODE
I
PLANS EXAMINER: PHONE:
FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE:
FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
I
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE:
FAX:
INSPECTOR(S):
1 BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: 0
YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 0 YES 0 NO
DATE: I STAFF:
ilMETHOD OFPAYMENT:
0 p ® r p IIIIIIIIIIIIIIIIIII
CASH CHECK L�
amummi
BANKCARD#; EXP/RES, VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
MY Ors 0/11111 i� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
►�`� O iii Spokane Valley,WA 992.6 509-688-0037-Fax
ValleY. For Inspections, call 509-688-0054
400*
'Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
•
(street) (city/state) (ZIP)
CONTRACTOR: 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 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 A PPL. - X $10 •
17 GAS PIPING(ea.Outlet) - X $1 •
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - I 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/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 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 PAYMENTPLUS PROCESSING FEE: $35.00
I- ---Viz ,'.;
SUMMON
M TOTAL PERMIT FEE DUE:
VISA •❑ CASH ❑ CHECK ❑ iMigi ❑ �— ••-V.t
DATE: EXPIRES:
BANKCARD NUMBER'
AUTHORIZED SIGNATURE:
aro<x +� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
e Spokane Va11 y,W.r.- 99206 509-688-0037-Fax
4000 Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR LICENSE#:
MAILING ADDRESS: PHONE#:
(street) (city/state) (LU') •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS i X $6
2 URINALS
X $6
3 TUBS
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 X ..5 SINKS
LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER
7 CLOTHES WASHER X $6 -
X $6 -
8 GARBAGE DISPOSAL
X $6
9 WATER SOFTENER
X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X .,11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE $6
X $6
12 FOUNTAINS,DRINKING - X
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR,
WASTE,VENT,PLUMBING. REVERSALS
REVERSAL X $6 -
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X
15 WATER USING DEVICE $6
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 $6
17 SPRINKLER SYSTEM
18 INTERCEPTORS X $25
GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X
20 MISC.PLUMBING FIXTURE $6
X $6
vIETHOD OF PAYMENT SUBTOTAL:
3 CASH ❑ CHECK 0 0 `_ _ _ i PLUS PROCESSING FEE: $35.00
TOTAL PERMIT FEE DUE:
>ATE: EXPIRES:
SANKCARD NUMBER:
LUTHORIZED SIGNATURE:
J ® 61p - s D,r,muEuCmPv oCEr
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NSPECTIO E TIONS
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