2004, 06-15 Permit App: BLD-04-04615 Addition , , 10 46 IS--
, BUILDING PERMIT APPLICATION WORKSHEET
San' City of Spokane Valley Community Development Department
ii: �e 9
Buildin Division
Valle11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: / 6' /4 7r- E
Assessor's Tax Parcel Number(s):
Legal Description:
PERMIT DESCRIPTION:
'wilding Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement D Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Rr---Owner: --1FA✓1 S q- Cara.. arker( El Applicant:
Phone: -27( Fax: ?93 ZZ( Phone: Fax:
Address: / ' Address:
r7lecifv/KeEw . .1•014
City State Zip Code City State Zip Code
❑ Contractor: &,.-14f3D✓6 El Architect: DScar er1Qs
Phone: Fax: Phone: -T4- S21-0, Fax: .9.0_-;wL
Address: Address: �or-e-r
. O.e t ± � 02--
City State Zip Code C' State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION .
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: i
MAIN FLOOR TO SQ. FTG: /_a 2""FLOOR SQ. FTG. UNFIN BASEMENT SQ. FTG:Apt.
FINISHED BASEMENT SQ. FTG:0 GARAGE SQ. FTG: .75-0 DECK/COV. PATIIODSSQ. FTG:
OCCUPANCY GROUP& AQ � CONSTRUCTION TYPE: /^oOA HEAT SOURCES r/
#OF BEDROOMS: ( TOTAL HABITABLE SPACE:(z IMPERVIOUS SURFACE AREA:
COST OF PROJECT: ' 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
71 3S/ SYSTEM? OBJ-SITE s PT1L
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: •Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
I nspector(s):
DISCLAIMER
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.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash 13241eck 0 Mastercard 0 VISA 0 Other
Bankcard#: Expires: VIN#:
Authorized Signature:
MECHANICAL PERMIT APPLICATION
orkam,\I*4 ,
Sial5O•AawawrCity of Spokane Valley Community Development Department
BuildingDivision
galley
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: 1 ni 4 F. .711 Permit Use:
Owner: -TO iS cr e rot iiure0 Phone(Daytime Contact): 83 -2.(Z(
Mailing Address: 1;q3141 C. ler (7✓-,eplaoD LJLA- c9,76/6
City State Zip Code
Contractor: (nOtleI)) License#: Phone#:
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK _ UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
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 =
USED APPLIANCE(WSEC mus.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE ( X $10.00 =
13 RANGE X $10.00 =
14 DRYER I X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS 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 $19.00 =
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 3-15 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 $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA U MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
i
PLUMBING PERMIT APPLICATION
Sfiolane City of Spokane Valley Community Development Department
BuildingDivision
�y 1 1707 E. Sprague Avenue, Suite 106
4.'1/alj Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)686-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: 175.K I- /. rl'Ave Permit Use: ,4bbt7io,,)
Owner: r-TrAil i S q- Cif 0. f1d1L v1 Phone (Daytime Contact): g9 212(
Mailing Address: I l( f. AUK-- 6 oe Oa(1o5 Nilk- 7i(.
City State p Code
Contractor: GAMr) License#: Phone#:
Mailing Address: -
City State Zip Code
#OF r TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS I X $6.00 =
2 URINALS 2 X $6.00 =
3 TUBS 0 X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6.00 =
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, . X $6.00 =
JANITOR,PHOTO,X-RAY.FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER / X $6.00 =
7 CLOTHES WASHER X $6.00 =
8 GARBAGE DISPOSAL Pr X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL "07X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE /EQ-
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP � X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: - X $6.00 =
VATS,TANKS,BOILERS /`e
18 INTERCEPTORS GREASE TRAP,SAND TRAP,
0. X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN _ X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK ❑ VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
FINAL AS-BUILT INSTALLATION •
.....
11/0 .•• NOR1 H
/
154
1
/84
... . _ • L000s!
C• I - •
i ID al 13' A CIL"
I 2'
• - 74,St 4:St.i
-4.11-37s1
I
1 i i I
1 1 1 i
itva. Ill' 'IV I
I i 1. i I 0.51
2'I 1
i21
4-1 i I I
I I I I
1 I I •
I
A.._
_ ---.20.51------
t ),;* , e ,.,74
SYSTEN, c. .'rtc....1'N 1E, t•Y ItiE 041AtIP'-'
NOT -TU di. CONSTRUED AS A"—
iXACT LOC.IMON OF THE SYSTEu. 201 it)91-111/4
REMARKS (continued) :
J/1.44(
1
•
•
qc,-oto
_________
_____ tfrxiti 3/93
. • .
— .
.„ • ,
1 i•
ADORE" 04,
ZONE
ROAD ' II
Fame 1 orwielegri
comuENTs
ReviEWED B -,-
'IP 4 e_Ai
. JA4,14A..-k---i pt • , .
.. 1
...._ ;
,-A
Mi. site
ii..._AVreption9t . • .614itteilla
\\\\\ \\\* 1 -""/Cilfrittati" Of--aw"fittjtalia"NO f...-
-w
trilve b.21111/orts th4) ba.,,aine the
\ \\ ,‘. .... -iwn kitonaseuffib.c iiiierrit is i gra. Miro...
• IIN a_ liof
-- • 440 stAsektorookit "vreect
c4.., \ Stnect: • _
Oak , Pftplotr
- :••••-1 \\ ,,
CA*-•,,%,--- , areas:
PP ---1-- )161'1 \ N \\
' / 1'• \
4— 6,. ,,-:- A4 N ''', ' \ \\
,
.er---
ct \
-------1
\\- ' c ii(0
, , . \AVALSQ'
N
—
,
A
„42,,-,t,tiN)
/,'
/Qd.1,7
/ ' -- ,,, --- . , ' 71 2, 2 7
2
*--"i- ;,::., ---.....„„i-,g,!;!'t .- '__, ,..-