2004, 03-12 Permit App: BLD-04-03752 Residence , - Ne et,, ...\‘,/,
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BUILDING PERMIT APPLICATION WORKSHEET
Sp
ate' kane m 110. ir ' ' City of Spokane Valley Community Development Department
Building Division
lleY 11707 E. Sprague Avenue, Suite 106
410,VaSpokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /9/ /q L _ l
Assessor's Tax Parcel Number(s): �"S2 0 Z.G 2 -7 (11e' -
Legal Description:
PERMIT DESCRIPTION:
Building Permit Change in Use ❑ Grading ❑ Manufactured Home
(l Relocation ❑ Tenant Improvement I I Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
•
je Owner: 5-x'6// -5774.1e4/4-
?/ Z. n Applicant:
Phone: 9'A 9 9dd Fax: 0- Phone: Fax:
Address: / 9.Z06 Gr, if Address:
.50,A. ..._ ...., zve. , 9":15./
City State Zip Code City State Zip Code
11 Contractor: c-R /174C-71, �e.�*f". ❑ Architect:
Phone: 9c - y Fax: 1/4'(-2e11/ Phone: Fax:
Address: /0:o ,4 .ic zX 9i5 Address:
5"/c7eJc a... Lva_ 99 2
City State Zip Code City State Zip Code
WA State Contractor License #: G lij` e-/1c 7'el1'9 Contact: G-. /
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: / , ' DIMENSIONS: x 36 #OF STORIES: ,
MAIN FLOOR TO SQ. FTG: 2ND FLOOR SQ. FTC: UNPIN BASEMENT SQ. FTG:
ls, 1a32_,
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTC:00 9 U DECK/COV. PATIO SQ.TC:
,
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
,5";L,..,/ �G� Gads
#OF BEDROOMS: TOTAL HABITABLE.SPACE:O IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
' ' 9x?- SYSTEM? - -pC.
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:
Inspector(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 ❑ Check ❑ Mastercard 0 VISA El Other
Bankcard #: Expires: VIN#:
Authorized Signature:
FROM :GENE PLETT CONSTRUCTION FAX NO. :509-466-8946 Mar. 11 2004 08:34AM P2
PLUMBING PERMIT APPLICATION
Sigkan‘liel\10% City of Spokane Valley Community Development Department
BulldingDivlsion
11707 E. Sprague Avenue, Suite 106
4,Valley ,
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL 009)688-0054
Project Address:/9.-Ia , Lf' y��, Permit Use:
Owner. S y 4/.(— 7271.L474 Phone (Daytime Contact): gz/-9 Y d e
Mailing Address: / 90.0 e L Y'41. .5./.0'e'ek i>01-5w'-- 99D14
City State Zip Code
•
Contras-../31,-4..o 1-4_ /11'`4 License... . Phone#: 9, Y-"-g lir-7
Mailing Addre.,_. - ..1 - . - •
City State Zip Code
- 0OF TOTAL •
DESCRIPTION OF WORK UNITS X COST • AMOUNT
1
1 TOILETS WATER CLOSET,BIDETS x 56.00 =
2 URINALS
Q X $8.00
3 TUBS ) X $6.00 = _
4SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT t X 56,00 a
5' SINKS LAVSIBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, 41 X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD.
PREP/CULINARY/MEAT ,
8 DISHWASHER X $6.00 =
7 CLOTHES WASHER / X $6.00 7-
8
8 GARBAGE DISPOSAL. / X 58.00 s
9 WATER SOFTENER ' X 56.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS.SEE MECHANICAL 0 X - $6.00 =
11 FLOOR DRAINS AREA,CASE.COIL TRENCH. X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $8.00
19 FOUNTAINS.DRINKING < X . 56.00 =
14 WATER PIPINGIDRAIN-IN WASTE, INSTALLATION,ALTERATION, I', a X $6.00
VENT. PLUMBING,REVERSAL REPAIR REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP I X _600 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB.STEAMER PROOFER, 6 X 56.00 =
CARBONATOR.SWAMP COOLER
.17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE.AND RP,B.P.D.FOR Q X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP.SAND TRAP. Q X 56.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN 0 _ X 5&00 =
•
20 MISCELLANEOUS PLUMBING FIXTURE 0 X $6.00 =
METHOD OF PAYMENT: • SUBTOTAL
0 CASH CI CHECK 0 VISA 0 MASTERCARD PROCESSING FEE _ $35.00 • •
DATE EMPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
MAR 11 2004 08:35 509 466 8946 PAGE.02
FROM :GENE PLETT CONSTRUCTION FAX NO. :509-46E-8946 Mar. 11 2004 08:34AM P1
•
, ^sok
• MECHANICAL PERMIT APPLICATION
SWOCity of Spokane Valley Community Development Department
�Q� • BuildingDivision
.00V
ue 11707 E.Sprague Avenue, Suite 106
�{a Spokane Valley, WA 99206
Phone: (509)688-0036:Fax: (509)688-0037
FOR INSPECTIONS,CALL(509)688-0054
f
Project Address:
/9 '2..‹.? . s*- 0-
Permit Use:
Owner. '5y1,4 5-t/ek.1IcL Phone(Daytime Contact):
Mailing Address: 15'.2 a ( Lr- t1 i_2)./ r.Pa!-C4.. - Lid Leis • q 9 4/L
City ' State ,,,Zip Code •
Contractor:` /ge t f License#: . Phone#: -/Yom
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 Si 5.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 s
3 , UNLISTED APPLIANCE(A4ditionat Fee) Equal to or less than 400.000 , X $50.00 =-,
d UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 ,_
USED APPLIANCE(WSEC min,AFUE
Ti ,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 X $10.00
15 FUEL BURNING WATER HEATER ' , X $10.00 v
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
•
17 GAS PIPING(each outlet) X $1.00 _ _
18 DUCT SYSTEMS i X $10.00 =
19 VENTILATING FANS .7 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 dung) 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 =
20 AIR CONDITIONER 3-15 TON J 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 $80.00 -,
30 LPG STORAGE TANK X 510.00 =
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 ❑MC DATE: PROCESSING FEE $35.00
CARD a: EXPIRES: TOTAL.PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
•
MAR 11 2004 08:34 509 466 8946 PAGE.01
. •
call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
Spokane
.00117alley
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit # 04-146 Account#
ROW CONSTRUCTION PERMIT
Location of property 19114 E. 4th Ave.
(Address/Parcel#, if available)
Applicant Name Sybil Sturgill Fax
Address Phone
Contractor's Name Gene Plett Construction
Address P.O. Box 28935, Spokane,Wa. 99228 Phone 509-993-5757
Contractor's Reg.# GENEPC*20109 Expires 8-13-2004
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
nSewer Connection ■ Driveway
111 Curb & Gutter n Gas Installation/Repair
n Cable/Conduit/Pole n Sidewalk Repair/Construction
n Water Installation/Repair Other
Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved Dated
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Si.nature
Fees Paid$ 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.
r
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE
This site plan isbeing
P°t being mit and is a Woe isubmitted for the PUt
obtaining a builkflOw.n
ding as y
1epresentation of the proposal.1' A11
es,structure,aft0 eildil
have imengionn corn dfrls
have been identified. Also 1\1
bodies of wader, steepslopes ,
--= -� %:�� T AVE.
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COMMENTS
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