2004, 04-23 Permit App: BLD-04-04178 Residence BUILDING PERMIT APPLICATION WORKSHEET
SChT\' l 1011 1# City of Spokane Valley Community Development Department
pneBuilding Division
Val le 11707 E. Sprague Avenue, Suite 106
400, Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: 155 2a d E. Lo Lana
Assessor's Tax Parc�el Number(s): H5 oC 3 I . 15 1 q
'the egad- IAA.84 -t. of the socr44h ho..1:F. oC lack 135 of l/ QS pee.
Legal Description: ?Lai- reedordeci in votunnn .,p„ pc ,Iasi Pa.a 3o,,records of Vero./
Co,
Ptiel,6or; except-the ' , . . e - exec. , — - • e.. Sc d. - ►n Po. •on- ,. .s. init5Ort.
PERMIT DESCRIPTION: /V C i _r/ 7. / r„,,,,,, i 0 „s.,e
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation n Tenant Improvement n Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: -Dave BouJers n Applicant:
Phone: 92-7-4(Q-1( Fax: Phone: Fax:
Address: ilic 5, S- Charles Address:
�OAka.rte V&iley i Wet. 49037
Ci State Zip Code City State Zip Code
❑ Contractor: ❑ Architect:
Phone: x: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
Z(0' L101 x 7O' (s" Z
MAIN FLOOR TO SQ. FTG: 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
It egO 11,4q L s0
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
1000 95g 41D
OCCUPANCY GRO P: CONSTRUCTION TYPE: HEAT SOUR E:
✓, A totes... /y Wcibd Frame G•4J rec d 41/r
#OF BEDROOMS: , / TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
��ff 0 O
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
150, ODD SYSTEM? Server
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 n 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 //�v iX /�oc. er-/ Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ZrVISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
THIS IS NOT A PERMIT
SO'
�� - Penalties wi •e • ; •
p � commencing work without a permit
4 . ey NEW SINGLE FAMILY RESIDENTIAL
11707 E.Sprague Ave.,Suite 106
Spokane Valley,WA 99206 Application #: BLD-04-04178
Job Address: 15221 E 6TH LN Applied: 04/23/2004
SPOKANE VALLEY WA 99037 Issued:
Description: NEW RESIDENCE W/ATTACHED GARAGE-NATURAL GAS Expires: 10/20/2004
(OWNER IS CONTRACTOR)
Subdivision: Lot: Blk: Parcel No: Zoning:
Owner: BOWERS, DAVID E&LISA M
Applicant: BOWERS, DAVID E&LISA M Phone: (509)927-4671
Address: 1115 S SAINT CHARLES RD
VERADALE,WA 99037-8831
Contractor: Phone:
Address: Lic No:
General Information: Fees:
TYPE OF RESIDENTIAL PERMIT sfr PLAN CHECK FEE 762.62
VALUATION 262598 BASIC PERMIT FEE 1,906.55
BUILDING HEIGHT TO PEAK 26 WSBCC SURCHARGE 4.50
DIMENSIONS 40 X 70'6" TOILETS 24.00
#OF STORIES 2 TUBS 18.00
#OF BEDROOMS 4 SHOWERS 6.00
FRONT SETBACK 35 SINKS 36.00
REAR SETBACK 40'6" DISHWASHER 6.00
LEFT SETBACK 17 CLOTHES WASHER 6.00
RIGHT SETBACK 231 GARBAGE DISPOSAL 6.00
OCCUPANCY GROUP r-3 WATER SOFTENER 6.00
CONSTRUCTION TYPE 5-n FLOOR DRAINS 6.00
STRUCTURES ON PROPERTY 1 WATER PIPING/DRAIN-IN WASTE 12.00
SEWAGE EJECTOR 6.00
CURRENT PROPERTY SIZE 128 X 306
SERVED BY SEPTIC SYSTEM no WATER USING DEVICE 18.00
FUEL BURNING APPL<= 100,000 15.00
WELLS LOCATED ON PROPERTY no GAS LOG, INSERT, FIREPLACE 20.00
TOILETS 4 RANGE 10.00
TUBS 3 DRYER 10.00
SHOWERS(PER TRAP) 1 FUEL BURNING WATER HEATER 10.00
SINKS 6 GAS PIPING 6.00
DISHWASHER 1 VENTILATING FANS 40.00
CLOTHES WASHER 1
GARBAGE DISPOSAL 1 Total Calculated: 2,934.67
WATER SOFTENER 1 Deposits/Receipts: 0.00
FLOOR DRAINS 1 CITY OF SPOKANE VALLEYdal Due: 2,934.67
WATER PIPING/DRAIN-IN WASTE 2 APPROVED FOR SUBMITTAL Sijal
SEWAGE EJECTOR 1 ..• • ��
WATER USING DEVICE 3 initials/ Date
REVIEWED FOR CODE COMPLIANCE
FUEL BURNING APPL<= 100,000 1GAS 8 POItANE V B INCA DIVISION
RANGOG, INSERT, FIREPLACE 1 Building (\/ ,.�0.�7��i 4c
DRYER FUEL BURNING WATER HEATER 1 Planning -lti
GAS PIPING(ea.OUTLET) 6 •''
VENTILATING FANS 4 Public Works ,
TYPE II HOOD 1
THI T A REC :.-7 1 KA
W
CLL _ i -4_7
MECHANICAL PERMIT APPLICATION
SITiOF City of Spokane Valley Community Development Department
pokane BuildingDivision
��� 11707 E. Sprague Avenue, Suite 106
40,ValSpokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
t ) ane. FOR INSPECTIONS, CALL(509)688-0054
Project Address: i S Z2 l e i vD �ie- Permit Use:
Owner: 'Dade 46eu)elrS Phone(Daytime Contact): cion-'(loch M1^4329
Mailing Address: tit S. CharlesSPnkane Va.1lcy I lnla� CNC 31
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 1 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 Z X $10.00 = ZO
13 RANGE I X $10.00 = t a
14 DRYER I X $10.00 = I0
15 FUEL BURNING WATER HEATER ! X $10.00 =
16 MISC.FUEL BURNING APPLIANCE / X $10.00 =
17 GAS PIPING(each outlet) p X $1.00 =
18 DUCT SYSTEMS I X $10.00 =
19 VENTILATING FANS 9 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 170
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: 4 15
AUTHORIZED SIGNATURE:
N i
PLUMBING PERMIT APPLICATION
Spokane Oiligi"I\ICity of Spokane Valley Community Development Department
i�(_j ne BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
t r FOR INSPECTIONS, CALL(509)688-0054
Project Address: 15121 E. loth lane Permit Use:
Owner: t'c ve "B.OWVer s Phone (Daytime Contact): i 2't-q 671 �1-93
ce 9
Mailing Address: 1(15 S. S. Ch0.Yres Spbka.�e Valley l State 9 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 Li X $6.00 = Z4
2 URINALS X $6.00 = 9
3 TUBS 3 X $6.00 = 1 —
•
4 SHOWERS(PER TRAP) BATH,STALL ON-SITE BUILT 1 X $6.00 = (p
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 = 31��-
JANITOR,PHOTO,X-RAY,FOOD, ff -- 7
PREP/CULINARY/MEAT (D
6 DISHWASHER ` X $6.00 = O
7 CLOTHES WASHER ( X $6.00 = (
8 GARBAGE DISPOSAL 1 X $6.00 = ID
9 WATER SOFTENER ( _X $6.00 = le
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL j X $6.00 = Co--
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 = 0
r,,_
CONDENSATE 1 (
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 = /2 -
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS _
15 SEWAGE EJECTOR GRINDER,SUMP PUMP I X $6.00 = Co
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 = t
CARBONATOR,SWAMP COOLER 3 `S--
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 1540
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: A MI .—
BANKCARD NUMBER:
AUTHORIZED SIGNATURE: