2003, 09-19 Permit App: BLD-03-02518 Residence soryounoe\..„ .. .
e , % 03 ,-- S-1 /
4000Valley
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:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 1 1 J 2 7 E- i- -)e--o (CCS . -e_ v'q,2Ej 6
ASSESSOR'S TAX PARCEL NUMBER(S):iiW5—L I : 6 C.� �'
LEGAL DISCRIPTION: C7 i PU 'k---%.I VI A-v PT 0, � I3 S Y2 o E KC)C I v.e 4/ 16 1 1
t v % G X C.. S 2s r-1
PERMIT DESCRIPTION: N -kw /lo
DUILDING PERMIT a CHANGE IN USE I]GRADING 0 MANUFACTURED HOME
QRELOCATION Q SIGN Q TENANT El OTHER
OWNER / APPLICANT INFORMATION
1
® OWNER: J t 04 L -2 Cl A ® APPLICANT: ' ✓'� t E---P Q iA_
PHONE: 6.12. ), V1t31c FAX: 9 \11 '1/ PHONE: 6C.2 «3 c-( FAX: :)1 , S4 7
ADDRESS: i' b5 E 1\- S S S(to A 5P Liw-tL'k ADDRESS:
ere/2/6 CITY,STATE,ZIPCITY,STATE,ZIP
f
°CONTRACTOR: � L L--PC-L C C !„St. ' 0 ARCHITECT: ,( -' -5 I J.Q 5, 3 k S i--uc(Co
PHONE: 12 6 L CV3 C( FAX: 2l et t. l 7 3 PHONE: vs-6 (2 76> FAX: (..)'y
ADDRESS: C(,""� 1C>ADDRESS: ID i ) S 5 ; -t �
CITY,STATE,ZIP k. , CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# M6t-pa 4 G S30 9 CONTACT: S( , s
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 2,C,i'C'e).cw 30%SLOPES ON PROPERTY: ill 0 MAIN FLOOR SQ FT: i 00
BUILDING HEIGHT TO PEAK:2-j I OCCUPANCY GROUP: 2ND FLOOR SQ FT: (`((7O `N
72--tarictgf
BUILDING DIMENSIONS:rrol CONSTRUCTION TYPE:54 °V-- I�fa ' UNFIN BASEMENT: X
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: ----- FINISHED BASEMENT:
Uri
NUMBER of BEDROOMS: # 3 CRITICAL AREAS: GARAGE: 7 3 3 SY i
FLANKING SETBACK: CURRENT PROPERTY SIZE: w0 X 3495 COVERED DECK: fe'b 2U
FRONT SETBACK: /.../5-
CURRENT PROPERTY USE: I-.o{' DECK:
REAR SETBACK: '.2,O 7 CURRENT SEPTIC USE: \)c,vt o'
LEFT SETBACK: I l CURRENT WELL USE: IVc A-4
RIGHT SETBACK: I 0 IMPERVIOUS SURFACE AREA:
IMANUFACTURED HOME ',, SIGN I
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 I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE __-: I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I _ - I
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
i4 BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES 0 NO
IDATE: I STAFF: 1
METHOD OF PAYMENT:
T
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
CITY t � 11707 East Sprague Aenue,Suite 106 509-688-0036-Phone
�neSpokane Valley,WA 99206 509-688-0037-Fax
,000Valley
Mechanical Permit Application
PROJECT t: w
ADDRESS::1 )b 7 l� 1 S! o L Lst I,c.,',,99'24, USE:
OWNER J t' 4..\t L- te,K PHONE(Daytime Contact): b9 9 6 i s 5>
MAILING ADDRESS: /�
1 3c>3 Ai ss,cc., 5aku,,i,_ t,,_,o9 (6
(street) (city/state) (ZIP)
CONTRACTOR: R
LICENSE#: / 0 5-36
MAILING ADDRESS: PHONE#: j 1 ry(.
135o � /t'1(•SSS, (� c
�u GP e4 K Q (/�1.1
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE •OR<100,000 Or' X $15 3G)
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 INSER 'GAS FIREPLACE - X $10 =
13 RANGE ”` - X $10 -
14 DRYER - r X $10 - i
15 FUEL BURNING WATER HEATER - I X $10 -
16 MLSC.FUEL BURNING APPL. - X $10
17 GAS PIPING(ea.Outlet) - .frb X $1 - b
18 DUCT SYSTEMSX $10 = ((;
19 VENTILATING FANS - 41 . X $10 - ''20
20 AIR HANDLER(DOES NOT indude ducting) =OR<10,000CFM X $12 -
21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10
23 TYPE I HOOD - X $50 •
24 TYPE II HOOD - I X $10
25 HEAT PUMP/AIR CONDITIONER 0-3 TON i 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: 6
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
MEM7 TOTAL PERMIT FEE DUE: 'r / I"
❑ CASH ❑ CHECK ❑ =Min ❑ L___.:::::._-:.
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
SCcrr4�x1r01' � 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
4.00Valley
Plumbing Permit Application
PROJECT , Lf h PERMIT
ADDRESS: 1 b "� USE:
OWNER: Nl ti\cL �e PHONE(Daytime Contact):
d t•�
MAILING ADDRESS:
\ '36 --S -.47, ll j,'s-sr_ ,,
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE It:
MAILING ADDRESS: PHONE It:
(street) (city/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS It OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 4/ X $6 - G'/
2 URINALS X $6 -
3 TUBS X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 3 X $6 - (
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- �y X $6 - /�
RAY,FOOD,PREP/CULINARY/MEAT /
6 DISHWASHER / X $6 - 6
7 CLOTHES WASHER / X $6 - to
8 GARBAGE DISPOSAL / X $6 - b
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,
3
STEAMER,PROOFER,CARBONATOR, X $6 - ( a
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM__ BREAKER,CHECK VALVE,AND X -
(R.P.B.P D;FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 =
HOLDING TANK
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
METHOD OF PAYMENT SUBTOTAL: I /
I -7,-,":7 (7
VISA' • • 'rZrztf`"' - PLUS PROCESSING FEE: $35.00
❑ CASH 0 CHECK 0 MIIIMMIN 0 t_._ .-_.I.5.
TOTAL PERMIT FEE DUE: 1(.21 ,00
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
v\ ` igt cL Past t\ U 7 r-
c 7q( 767
\ b 0
APPROVED BY ., '
-. ''0S-/- AkAA-A-A4A-A-4-44 _ ft-ts-J Cd5/1-d---el-f
1
I ap,
v,,r
1 \.C;
), 1111111111J
vArt
S
0
. k MI .
--)
o i . '7::::i*V4'.,.trfitT4,.--.T_- .
t ./1 r
t i i :" '
r 00
i
g e (1
; ill . I
4
ii -r- ,, 3' \Vr
A i► ._ '..... ' __._ ._�.___._ ..._. i..