2003, 11-21 Permit App: BLD-03-03137 Residence crrV ue
ye
410 0#\isllcy 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:(503)688-0037
REQUIRED SITE INFORMATION
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STREET ADDRESS: ` U b'11 c_ 4-n-i 4 PC
ASSESSOR'S TAX PARCEL NUMBER(S): /I` `A x `� C
x)
LEGAL[ASCRIPTION: 5S--/
J l 1 r>
PERMIT DESCRIPTION: ?-ezotr.,-ra.frt-- �Azc-ral cr-fik.v—
UILI)ING.PERMIT a CHANGE IN USE a GRADING -a MANUFACTURED HOME
RELOCATION D SIGN E TENANT 0 OT ft ER
IOWNER / APPLICANT INFORMATION f
" OWNER: -r&L-7 `"1 APPLICANT: v4-14"t1 it S o✓'i"1 4.
PHONE: C0`-4 �rjlo6`7'/-S FAX: 'S-Di �LZ-:%3b
PHONE: FAX:
ADDRESS: / 3e1I ( ell \P01 -^1- Wim' `�`")Z)G ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
® ®
CONTRACTOR: ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
IPERMIT/BUILDING INFORMATION
COST OF PROJECT: 60,o 00 30%SLOPES ON PROPERTY: Nt,;JE MAIN FLOOR SQ FT: ,LJ'00
BUILDING HEIGHT TO PEAK: 29OCCUPANCY GROUP: 2No FLOOR SQ FT: q00
BUILDING DIMENSIONS: lip/y t CONSTRUCTION TYPE: kV!)Cu �--A -- UNFIN BASEMENT:
NUMBER OF STORIES: I 1 STRUCTURES ON PROPERTY: Ni1t�e FINISHED BASEMENT: "�
)0
NUMBER of BEDROOMS: 3 CRITICAL AREAS: &ic GARAGE: ,.444-C s a r- 1 z
FLANKING SETBACK: CURRENT PROPERTY SIZE: i'''t x di COVERED DECK: -0"
FRONT SETBACK: ledi' )-0 CURRENT PROPERTY USE: ,A.A DECK:
REAR SETBACK: 3$' CURRENT SEPTIC USE: +�0_-'C.
LEFT SETBACK: >1 CURRENT WELL USE: ,' -'c
RIGHT SETBACK: 147 IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN: `
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: .. TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
I WA STATE NON-RESIDENTIAL ENERGY CODE
I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
I
a BOLTING ®CONCRETE ® REINFORCEMENT a WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
I
BUILDING STAFF USE ONLY
I
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: ® YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: 9 YES ® NO
IDATE: I STAFF:
METHOD OF PAYMENT:
0 0 0 r- 0 miNgi i
CASH CHECK toyaifftSA
i romVImEN
BANKCARD#; EXPIRES, VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
(� rr or— 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Ncr3ol ane Spokane Valley,WA 99206 ' 509-688-0037-Fax
,,,,,•sValle
Mechanical Permit Application
PROJECT Kos- r..J. FELT1 PERMIT i,** - % �'�� �"
ADDRESS: `„tii
USE:
OWNER: 11r y„. ( g p"/f
„_ PHONE(Daytime Contact): (co,)�f 6 a-ci`�(�S
MAILING ADDRESS: ”^
13e(( E Sm SPoI44AJ tvA- .7,2/6
(street) (city/state) (ZIP)
CONTRACTOR: (��6�?, A 6,, LICENSE#:
�/tltDE7ZSow1 lJ
MAILING ADDRESS: •• PHONE#:
726-0560
•
(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 - 1 X $10 -
13 RANGE - I
X $10 -
14 DRYER - Z.. X $10 -
15 FUEL BURNING WATER HEATER - Z X $10 =
16 RISC FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - i 5 X $1 -
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 4 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 PAYMENT PLUS PROCESSING FEE: $35.00
Iiiiilli
t^ :: TOTAL PERMIT FEE DUE:
❑ CASH ❑ CHECK ❑ NM= ❑ -- '_4
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Ccrr�of 11707 East Sprague AvE�iue;Suite 106 509-688-0036 Phone
►Jp0 a Spokane Va111y,'WA 99206 509-688-0037-Fax
.0,00Milley
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: IS-9S N • �tTS • USE:
. OWNER: lotv. (�p"'�) PHONE(Daytime Contact): ( 1ySol) % -Loos
MAILING ADDRESS: • �' "
1t11 C S- crO1cA-Jr - c>9S(6
(street) (city/state) (all')
CONTRACTOR: LICENSE#:
MAILING ADDRESS: PHONE#:
•
(street) (city/state) (ZIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 -
2 URINALS X $6 -
3 TUBS 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- X $6 -
RAY,FOOD;PREP/CULINARY/MEAT
6 DISHWASHER I X $6 -
7 CLOTHES WASHER ;t I X $6 -
8 GARBAGE DISPOSAL 1 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, 3 X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VMS,TANKS,BOILERS X $6 -
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 -
SUBTOTAL:
ITHOD OF PAYMENT
alliiiii
. a"4'aSxr d• PLUS PROCESSING FEE $35.00
CASH 0 CHECK 0 MN= tJ ...11b...;
TOTAL PERMIT FEE DUE:
TE: EXPIRES:
VKCARD NUMBER
THORIZED SIGNATURE:
Call 24 hour§be'ore inspection required
Phone 509.688-0195 'Pat 509.688-0037
Sane
Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-054 Account #
ROW CONSTRUCTION PERMIT
Location of property 18621 E. 4thv Ave.
(Address/Parcel#,if available)
Applicant Name Jeremy Gray Fax
Address 13811 E. 5th Ct. Spokane Valley, Wa. 99016 Phone 509-868-4905
Contractor's Name Homeowner
Address Phone
Contractor's Reg.# Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ■ Driveway
n Curb & Gutter n Gas Installation/Repair
n Cable/Conduit/Pole ri Sidewalk Repair/Construction
Water Installation/Repair r7 Other
nPavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS: Construct asphalt driveway approach per Spokane County Standards
as adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved /c7-7= �
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature.
Fees Paid$ 25.00 25.00 Date !nit
(Application) (Inspection)
In addition to the permit application fee of$16.00(utility)or$25.00(construction), inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE
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,__4_ ____. — _�__ REVIEWED FOR CODE COMPLIANCE
`�{ SPOKANE VALLEY BUILDING DIVISION
PLANNING DEPT. , PPROVEC)
' , 11/
BY ►� �v .iA-eQ
� ' 51 PPS cP
DATE: b3.6 2 -°-1-1 „
: - (OFT.