2004, 06-03 Permit App: BLD-04-04483 Addition Sl
BUILDING PERMIT APPLICATION WORKSHEET
Ci'tT
City of Spokane Valley Community Development Department
Building Division
.000Valle11707 E. Sprague Avenue, Suite 106
evSpokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: CP(./ I b t AST 6,5 r� j
Assessor's Tax Parcel Number(s): 351q 2 25Oq
Legal Description: M ",ic'/ /14:l' 1 u I+i'c;Ali iitij r or /c t 3 tit G/t.'t ./ a( a fy 4 k_ic;,y
PERMIT DESCRIPTION: X /y A T)1l Tl DA.) U , 1 e F f l
�Buildin Permit Pn-cy- -2 e ,�-'�c� iv
Building ❑ Change in Use ❑ Grading ❑ Manufactured Hor`i
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
lY( Owner: JF\SMttit Smt- t-1 ❑ Applicant:
Phone: 93q_pycl y Fax: 8' Phone: Fax:
Address: (p t'l . (p th St Address: fr.. ,
SPOLAA)E \) M 1EKLoaf- 9 2/Z
City Sate Zip Code City State Zip C
❑ Contractor: ❑ Architect:
Phone: Fax: Phone: Fax: ' •
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
L\HEIGHT TO PEAK / DIMENSION • '
�� r ___ #OF STORIES:
MAIN FLOOR TO-SQ. TG: 2 FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BAS iENT SQ. FT GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
7-1/ 90 (/ • S-- - SYSTEM?
•
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: 2, 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
f ❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT 0 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 per it inure to the property owner.
Print Name, YASi•A• E 51A\'Z'i-1 Signature _ A.A JA : IAA
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash nCheck ❑ Mastercard 0 VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION
e01\ft6---r11)0"FlianCity of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
delSpokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS,CALL(509) 688-0054
Project Address: (p/(} F fh _ r. Permit Use:
Owner: L SM1 iCi 5 M ( Phone (Daytime Contact): 39-Oy9
Mailing Address: 6 (1110 F Co 1 ' 1
City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAVSIBASINS,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 X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: iF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE
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
18 INTERCEPTORS GREASE TRAP,SAND TRAP, 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
0 CASH ❑ CHECK ❑ VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
MECHANICAL PERMIT APPLICATION
1my "10City of Spokane Valley Community Development Department
SBuildingDivision
ley
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
4.001F Val
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL.(509)688-0054
Project Address: Permit Use:
Owner: Phone(Daytime Contact):
Mailing Address:
City State ., Zip Code
Contractor: 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 min.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 _
I
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 It 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 El MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
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shall be covered with approved material. i5''X, 61
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