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2009, 04-28 Permit App: 09001061 ResidenceProject Number: 09001061 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/28/2009 Page 1 of 3 Project Information: Permit Use: NEW SFR -GARAGE -SEWER Contact: POTTS, JAMES N & DEBORAH K Address: 20119E 8TH AVE C - S - Z: GREENACRES, WA 99016-9748 Setbacks: Front Left: Right: Rear: Phone: (509) 217-0953 Group Name: Site Information: Project Name: Plat Key: Name: Range District: Sout Parcel Number: 45222.4002 Block: SiteAddress: 12421 E 4TH AVE Location:: CSV Zoning: MF -1 MF MDR District Water District: 011 MODERN Area: 8,540 Sq Ft Width: 0 Nbr of Bldgs: 0 Nbr of Dwellings: 0 Lot: Owner: Name: POTTS, JAMES N & DEBORAH K Address: 20119 E 8TH AVE GREENACRES, WA 99016-9748 Hold: ❑ Depth: 0 Right Of Way (ft): 0 Review Information: Review Building Plan Review Released Driveway/Approach Originally Released: 4/27/2009 By: TMELBOU Ibeleased By: Originally Released: 4/28/2009 By: TMELBOU Landuse/Zoning/HE Conditions .Released Ey; Sewer Review Originally Released: 4/24/2009 By: mpalaniuk 'Released By: OK PER COLLIN @ CTY UTILITIES VIA PHONE CALL 4 -28 -09 -JM Originally Released: 4/28/2009 By: JLMain Operator: jmm Printed By: jmm Print Date: 4/28/2009 Project Number: 09001061 Inv: 1 Application THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Date: 4/28/2009 Page 2 of 3 Permits: Approach Contractor: OWNER Firm: OWNER Phone: (000) 000-0000 Item Description APPROACH -CONST IN ROW Contractor: OWNER DescriptionGir Type Notes 1&2 FAMILY R-3 VB COV DECK R-3 VB GARAGE U-1 VB Item Description RESIDENTIAL PERMIT FEE WSBCC SURCHARGE SF PLNS RVW < 7999 SQ FT Contractor: OWNER Item Description GAS WATER HEATER CLOTHES DRYER RANGE Operator: jmm Units Unit Desc 1 NUMBER OF Permit Total Fees: Building Permit Fee Amount $50.00 $50.00 Firm: OWNER Phone: (000) 000-0000 This Application: Total Project: Se Ft Valuation Sq Ft Valuation 1,540 $149,118.20 1,540 $149,118.20 68 $1,020.00 68 $1,020.00 431 $8,189.00 431 $8,189.00 Totals: 2,039 $158,327.20 2,039 $158,327.20 Units Unit Desc SELECT SELECT SELECT Permit Total Fees: Mechanical Permit Fee Amount $1,324.15 $4.50 $529.66 $1,858.31 Firm: OWNER Phone: (000) 000-0000 Units Unit Desc 2 NUMBER OF 1 NUMBER OF 1 NUMBER OF Printed By: jmm Permit Total Fees: Print Date: Fee Amount $22.00 $10.00 $10.00 $42.00 4/28/2009 Project Number: 09001061 Inv: 1 Application Date: 4/28/2009 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Contractor: OWNER Item Description TOILETSBIDETS SINKS SHOWERS TUBS DISH WASHERS CLOTHES WASHER FLOOR DRAINS Plumbing Permit — Firm: OWNER Phone: (000) Units 3 5 1 2 1 1 1 Unit Desc NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF NUMBER OF Permit Total Fees: 000-0000 Fee Amount $18.00 $30.00 $6.00 $12.00 $6.00 $6.00 $6.00 $84.00 Notes: Payment Summary: Permit Type Approach Building Permit Mechanical Permit Plumbing Permit Fee Amount Invoice Amount Amount Paid Amount Owing $50.00 $50.00 $0.00 $50.00 $1,858.31 $1,858.31 $561.02 $1,297.29 $42.00 $42.00 $0.00 $42.00 $84.00 $84.00 $0.00 $84.00 $2,034.31 $2,034.31 $561.02 $1,473.29 Disclaimer: Submittal of this application certifies the owner (or person(s) authorized by the owner) has both examined and finds the information contained within to be true and correct, and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for, or an approval of, any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: jmm Printed By: jmm Print Date: 4/28/2009 Sp0 ne .0w0Valleyk Community Development Residential Construction Permit Application Permit Center 11703 E Sprague Ave, Suite,B-3 NF VALLEY Spokane Valley, WA 99206 �;��A+ (509)688-0036 FAX: (8'8-O67 www. spokanevallev.org p 23 �New'CGHs j tion Ti Accessory Bldg - ;~Addition/Remodel Deck �n " Other: 2009 PERMIT NUMBER: PERMIT FEE: `11- j3'\ SITE ADDRESS: /Z 2-/ 4 $ /ttjt ASSESSORS PARCEL NO: 445.a-2- - 400 Z LEGAL DESCRIPTION: Building Owner: Name: ,j -4&s, !A // s Address: z//1/ & 1P- (r€e-ii/ke-s rte% City: 6r M A".4- State: Zip: gYoi Phone:,Fax: siOq- 21 -7 -ogS- Contact Person Name: .„,_2"--11,1 / iS Phone: ,Z 17 - S3 Describe the scope of work in detail: Contractor: DIMENSIONS: 21.1 SS Name:_...., -;4016.5 /), to TOTAL HABITABLE SPACE: Address: Zo //q E - 2"" FLOOR SQ. FTG: Ai E�- City: t; fte A ,4-c l"5 State: 0) Zr1e/G Phone:Fax: 50`7 _ Z[ 7 --0 9 ' F GARAGE S T ' Contractor Lic No: n / Ate: Exp Date:✓ �n r J AC- I'h 30% SLOPES ON PROPERTY: City Business Lic. No: CONST��`U CTION TYPE: doe. d' Cost of Project: $ y 2-- L Proposed Use: ,..5i4//e._ **************The following MUST be complete: (write N/A if not applicable)********************** HEIGHT TO PEAK: DIMENSIONS: 21.1 SS # OF STORIES: em TOTAL HABITABLE SPACE: MAIN FLOOR TO SQ. FTG: ', Qom, 14 `—/SS D 2"" FLOOR SQ. FTG: Ai E�- UNFIN BASEMENT SQ. FTG: �� IMPERVIOUS SURFACE AREA: FINISHED BASEME SQ. FTG: ' F GARAGE S T ' DE COV. PATIO FTG: 30% SLOPES ON PROPERTY: # OF BEDROOMS: 3 CONST��`U CTION TYPE: doe. d' HEAD- SO NUE: K'[Asii F40 ,✓ SEWER OR SEPTIC? t,✓ fir' The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. SIGNATURE: Method of Paymen D Cash Bankcard #: Authorized Signature: REVISED 2/15/07 iXf Check DATE: tt /i la, ❑ Mastercard ❑ VISA Expires: VIN#: Spokane Valley® For City Use Only PLUS Project Number > /001 Project Address 11703 E Sprague Ave Suite B-3 • Spokane Valley WA 99206 509.688.0036 • Fax: 509.688.0037 • permitcenter@spokanevalley.org As part of our on-going commitment to customer service during the review process of your project application, we are providing you with a TARGET DATE for the initial technical application review. If for any reason we cannot meet this date, we will contact you with a revised target date. Your application review TARGET DATE is 17//29/0c) The TARGET DATE is the date we estimate your project application will have had its initial technical review. It is not the date for approval or permit issuance. Tips for a Smoother Project Application Review > Submit complete, accurate plans and documents. Extra time may be required for re -submittals as project application reviewers work on multiple applications and it may be several days before they can look at your new or revised information. ➢ Designate a specific contact person to communicate with the City. While the person designated as the applicant's contact person with the City can be changed, one individual with the expertise for dealing with reviewer comments would be the best choice for the entire review process. ➢ Call staff regarding the status of your project only after the target date shown at the top of the page. Although you should be contacted on or by the target date, please feel free to contact us if you haven't heard from us by your target date. Staff may contact you before the target date if the initial review is complete. By following this procedure, you will save time and allow the reviewers to complete the work more expeditiously. Steps in the Permit Process 1. Counter Complete. Your application has been accepted as counter complete. This means all of the required documents, as indicated on your Pre -Application Checklist have been submitted or have been approved for deferred submittal. This does not prevent technical staff from requesting additional information as a result of their technical review. 2. Quality Check. The next step in the process is a quality check to make sure that the application is reviewable and free from substantive flaws that would prevent technical staff from completing the technical review once it is started. When this step is complete, your application will be routed to the appropriate staff and remain in their review queue until it comes up for review. 3. Technical Compliance. Once an application is administratively complete, it is routed to technical staff for compliance review. Depending on the type of project, technical staff may include multiple reviewers. You should be contacted by phone, fax, email, or mail by your TARGET DATE once the initial technical compliance review is complete. 4. Permit Issuance. When the technical compliance review of the application is complete, including any subsequent re - submittals, each reviewer will approve their section of the application and route it to the Permit Center. When all sections of the application are received, a Permit Specialist will process the application and contact the person specified on your application for permit pick-up. Information regarding fees and pre -construction meetings (if required) will be provided by the Permit Specialist at that time. WHITE -APPLICANT PINK - BUILDING FILE REV 9/07 /\ Permit Center S0 a 11703 E Sprague Ave, Suite B-3 P e Spokane Valley, WA 99206 Sf Va ey (509)688-0036 FAX: (509)688-0037 Community Development wx1v. kanevallev.ore Mechanical Permit Application PERMIT NUMBER: PERMIT FEE: n Commercial Residential SITE ADDRESS: /242 / t- 7 r " 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 $15.00 3 UNLISTED APPLIANCE (Additional Fee) Equal to or less than 400,000 X $50.00 4 UNLISTED APPLIANCE (Additional Fee) More than 400,000 X $100.00 5 USED APPLIANCE (WSEC min. AFUE rating) Equal to or less than 400,000 X $50.00 8 USED APPLIANCE (WSEC min. AFUE rating) More than 400.000 x $100.00 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 $60.00 12 GAS LOG, GAS INSERT. GAS FIREPLACE X 510.00 13 RANGE 1 X $10.00 14 DRYER X $10.00 15 FUEL BURNING WATER HEATER 2- x $10.00 16 MISC. FUEL BURNING APPLIANCE X $10.00 17 r:GS PIPING (each outlet) X $1.00 18 DUCT SYSTEMS x $10.00 19 VENTILATING FANS X $10.00 20 AIR HANDLER (DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 21 AIR HANDLER (DOES NOT include ducting) Greater than 10,000 CFM X $15.00 22 EVAPORATIVE COOLERS X $10.00 23 TYPE I HOOD X $50.00 24 TYPE II HOOD X $10.00 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 26 AIR CONDITIONER 4-15 TON X $20.00 27 AIR CONDITIONER 15-30 TON X $25.00 28 AIR CONDITIONER 30-50 TON X $35.00 29 AIR CONDITIONER More than 50 TON X $60.00 30 LPG STORAGE TANK X $10.00 31 WOOD OR PELLET STOVE/INSERT X $10.00 32 WOOD STOVE - FREE STANDING X 525.00 33 REPAIR & ADDITIONS X $15.00 34 VENTILATION SYSTEMS X 512.00 35 VENTILATION MECHANICAL EXHAUST X 512.00 36 INCINERATOR - RESIDENCE X $19.00 37 INCINERATOR - COMMERCIAL X $22.00 METHOD OF PAYMENT: ❑CASH ❑ CHECK 0 VISA 0 MC CARD rt AUTHORIZED SIGNATURE: REVISED 826/05 EXPIRES. VIN: SUBTOTAL PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: . Name: 4 f[5 Phonrren 7n-01153 Fax: .�amr� Address: //9 r- 5y city.,e�� , State:Zip: �,( "�7 Contractor iPy .. Name:-rm-nies lOiv. Phone: Sal_ 247 _01 r-3 Fax: Address:- �llR t�r'%t- City: GfP21l f}yGSL./r4 1 State: � Zip: �d�fo License No: �% owned am (dam City Business Lac: Name: Phone: 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 $15.00 3 UNLISTED APPLIANCE (Additional Fee) Equal to or less than 400,000 X $50.00 4 UNLISTED APPLIANCE (Additional Fee) More than 400,000 X $100.00 5 USED APPLIANCE (WSEC min. AFUE rating) Equal to or less than 400,000 X $50.00 8 USED APPLIANCE (WSEC min. AFUE rating) More than 400.000 x $100.00 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 $60.00 12 GAS LOG, GAS INSERT. GAS FIREPLACE X 510.00 13 RANGE 1 X $10.00 14 DRYER X $10.00 15 FUEL BURNING WATER HEATER 2- x $10.00 16 MISC. FUEL BURNING APPLIANCE X $10.00 17 r:GS PIPING (each outlet) X $1.00 18 DUCT SYSTEMS x $10.00 19 VENTILATING FANS X $10.00 20 AIR HANDLER (DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 21 AIR HANDLER (DOES NOT include ducting) Greater than 10,000 CFM X $15.00 22 EVAPORATIVE COOLERS X $10.00 23 TYPE I HOOD X $50.00 24 TYPE II HOOD X $10.00 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 26 AIR CONDITIONER 4-15 TON X $20.00 27 AIR CONDITIONER 15-30 TON X $25.00 28 AIR CONDITIONER 30-50 TON X $35.00 29 AIR CONDITIONER More than 50 TON X $60.00 30 LPG STORAGE TANK X $10.00 31 WOOD OR PELLET STOVE/INSERT X $10.00 32 WOOD STOVE - FREE STANDING X 525.00 33 REPAIR & ADDITIONS X $15.00 34 VENTILATION SYSTEMS X 512.00 35 VENTILATION MECHANICAL EXHAUST X 512.00 36 INCINERATOR - RESIDENCE X $19.00 37 INCINERATOR - COMMERCIAL X $22.00 METHOD OF PAYMENT: ❑CASH ❑ CHECK 0 VISA 0 MC CARD rt AUTHORIZED SIGNATURE: REVISED 826/05 EXPIRES. VIN: SUBTOTAL PROCESSING FEE 535.00 TOTAL PERMIT FEE DUE: SPokan•/e 1Ualley Community Development Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.snokanevallev.org Plumbing Permit Application ❑ Commercial PERMIT NUMBER: PERMIT FEE: Residential SITE ADDRESS: Building Owner Name:Phoneme .� � 46_ o9-AZ17-0 X53 Fax: Address: 7_40 //Q e A274, 1 C ty� �T ,1 J /� �� ugJtep4._ Zip Jw" 4 / (e Contractor Name: SGS j9 725 Phone: Fax: Address: Z0/�q egi'L City:1r'r)A___�� State: (i11A- Zip. 9�� Cd. No: fc)i,,jP4/. Bv, /c%_7' City Business Lic: Contact Name: Phone: DESCRIPTION OF WORK # OF UNITS X COST TOTAL AMOUNT 1 2 3 TOILETS URINALS TUBS WATER CLOSET, BIDETS �Z X $6.00 X $6.00 z X $6.00 4 5 6 SHOWERS PER TRAP SINKS DISHWASHER BATH, STALL, ON-SITE BUILT X 7 CLOTHES WASHER LAVS/BASINS, BAR, FLOOR, KITCHEN, LAUNDRY, UTILITY, JANITOR, PHOTO, X-RAY, FOOD, PREP/CULINARY MEAT X X $6.00 $6.00 $6.00 8 GARBAGE DISPOSAL l X $6.00 X $6.00 9 WATER SOFTENER X $6.00 10 ELECTRIC WATER HEATER NOTE: IF GAS, SEE MECHANICAL X $6.00 11 FLOOR DRAINS AREA, CASE, COIL, TRENCH, CONDENSATE X $6.00 12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 13 FOUNTAINS, DRINKING X $6.00 14 WATER PIPING/DRAIN-IN WASTE, VENT, PLUMBING, REVERSAL NSTALLATION, ALTERATION, REPAIR, REVERSALS X $6.00 15 16 17 SEWAGE EJECTOR WATER USING DEVICE CROSS CONNECTION DEVICE GRINDER, SUMP PUMP ICE AN/OR COFFEE MAKER, HOSE BIB, STEAMER PROOFER, CARBONATOR, SWAMP COOLER VACUUM BREAKER, CHECK VALVE, AND R.P.B. P.D. FOR: VATS, TANKS, BOILERS x X X $6.00 $6.00 $6.00 18 INTERCEPTORS GREASE TRAP, SAND TRAP, CHEMICAL HOLDING TANK X $6.00 19 MEDICAL GAS (per outlet) NITROUS, OXYGEN X $6.00 20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 22 INDUSTRIAL WASTE INTERCEPTOR X $15.00 METHOD OF PAYMENT: ❑CASH 0 CHECK 0 VISA ❑ MC Card# EXPIRES: VIN: SUBTOTAL PROCESSING FEE $35.00 TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: REVISED 8/26/05 Spokane PERMIT CENTER 11703 E. Sprague Ave;, Suite B-3 Spokane Valley, WA 99206 509-688-0036; Fax 509-688-0037 www.sookanevallev.org Affidavit in Lieu of General Contractor Registration State of Washington ) County of Spokane ) I, -771514,...3 ,O WS state as follows: (Print name as signed) 1. I have made application for a building permit from the City c 2. I understand that state law requires that all building construe State of Washington. The exceptions to this requirement are which is printed on the reverse side of this affidavit. 3. I understand that prior to issuance of a building permit for w the City of Spokane Valley must verify either that the contra`` Washington, or that one of the exemptions stated under RCa 4. In order to provide verification to the City of Spokane Valle hereby attest that after reading the exemptions from the regi consider the work authorized under this building permit to b therefore, not be performed by a registered contractor. I understand that I may be waiving certain rights that I might othe decision to engage an unregistered contractor to perform construc.ion work. f Spokane Valley, Washington. ion contractors be registered with the tated under RCW 18.27.090, a copy of rk that is to be done by any contractor, for is registered by the State of 18.27.090 applies. of my compliance with this requirement, I ation requirement of RCW 18.27.090, I exempt under No. , and will ise have under state law in any oswun 4444% iA,t 02.,%„ iOpeJG to, „t 09 .emsr 11j ° 1 WAS �.`� s Signed .S D d sworn to beforewa this y of,20©'1 l�iame (Prmi la I Notary ignature NOTAR PUBLIC in and for a State of Washington, residing at Cc County My Com II fission expires: 9-9- /1 October 15, 2007 Page 1 of 2 1 :\Community Development\Forms\Building Forms 12 4' a -1[ J oie 01'1 v.•,..w aw e PLANNING DEPT. APPROVED BY. DATE: `(lzy/z,a,9 i • 33' P„ pvi„i L„K 7brst SS 0 TrI/-' 31-,4” a..)U ADD11Sl, D%MC411)0r15 WIS 11% PGvRfo P+ M ZM% goltDSQ, ASE/4er''r a' 4045,4, £.,,s+ ,, r (SP) 5, Zc_ 1.2 X116. Spo elle y. Permit Center 11703 E Sprague Ave, Suite B-3 Spokane Valley, WA 99206 (509)688-0036 FAX: (509)688-0037 www.sookanevallev.org Community Development Approach Permit Application PERMIT NUMBER: PERMIT FEE: PROJECT ADDRESS /24L1 t -Ott 4-vtt START DATE ANTICIPATED COMPLETION DATE Building Owiiiai: ' �a.-,� ' ... Coattactor ,. , Name: ,,/;yynes oy/5 Name: avies ,/-o Address: go tic/ ` Address: 7 p X19 e Oft_ L City: attem A>; 'es State() t Zip: 90 GG City: 6, ye,i itk-still/zJ State: - Zip: WilL, Phone:f ZI7-09f Fax Phone:Fax: 534 -7J7 -o4 5'3 Contact Person ..0 , ... Contractor Lic No: 0/..me,/SC,iJ7�//���' � Date: Contractor Name: ..27 a1 A 7,/, City Business Lic. No: Phone:sag_ 7.,7_09s3 PROJECT DESCRIPTION (Provide site sketch) Residential Driveway Existing Curb & Gutter Culvert Installation Commercial/Industrial Driveway Rural Road Section Sidewalk Repair/Construction • Other Conditions Bond/Insurance certification must be on file with the city. DISCLAIMER The permittee verifies, acknowledges and agrees by their signatures that: 1) If this permit is for construction of or on a dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the property owner. 3) The signatory is the property owner or has permission to represent the property owner in this transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code. Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances. 6) Plans or additional information may be required to be submitted, and subsequently approved before this application can be processed. Signature /`I do Ifs Date . 24 , 20'9 Method of Payment: ❑ Cash 9 Check 9 Mastercard ❑ VISA Bankcard#: Expires: VIN#: Authorized Signature: REVISED 39188