2003, 09-24 Permit App: BLD-03-02584 Duplex City of (oW 003(p
SPOKANE VALLEY d )( (n rir'x037
•
PERMIT # i
B I DING PERMIT APPLICATION •
Box.1 OWNER GOOD 'Si t4A-R4 '50U
/JOB LOCATION=-1 yr
OWNER'S ADDRESS CITY PHONE RpII
17121 1:, $-1}4 F'i . G N A-441r 14A o14
DESCRIBE JOB Tb d : ►G al-ti •
THIS PROPERTY IS OWNED :Y: SINGLE/MARRIED
PARTNERSHIP C��RP. _ NON -PQoFIT O0-&ftNI2-Pt-IMO
30X 2 CONTRACTOR'S NAME 7i lj, KIP-ILLAD PHONE Slq- 43%0
CONTRACTOR'S ADDRESS S S, BEST CITY V t 1 v.)4-, .":Kb37
CONTRACTOR'S REG.# O2 . 1 EXPIRATION DATE '1 -Zl- !°171'
(CARD MUST BE PRESENTED AND COPIED OR VEF IFIED)
30X 3 CONTACT PERSON OF PROJ:CT +3J �.{CLApJp PHONE 87? ��3S�o
ADDRESS At/WE CITY /t-eOJ ZIP
iOX 4 SEWER AVAILABILITY VES-- C1-1-11 Sealy, VA-LWATER AVAILABILITY YES—
1OX 5 ESTIMATED PROJECT COST$ 7-601600 EXISTING BLDG.VALUATION$
;OX 6 PROPERTY TAX ACCOUNT NUM: R •
LEGAL DESCRIPTION 1,4-r- �.Q 4 21 Ste..-IOVJ 241 R 4+.I.as;•I
V ZLEAl IZADC,E POD .
Lk
(IF NECESSARY, PLEASE �� ��� ��C�
SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
• CENSUS NUMBER LOT NUMBER
DX 7 BUILDING SQUARE FOOTAGE Existing/proposed) 1ST FLOOR D / 2 (.02( 2ND FLOOR - -
3RD FLOOR --7` OTHER / BASEMENT FINISHED —7'--
BASEMENTUNFINISHED D
DECK
/ GARAGE b / Ii4Op
CARPORT —7 - TO L / HEIGHT TO PEAK OF BUILDING %I-) I FT.
)X 8 ( ) SINGLE FAMILY
(X) MULTIFAMILY(NO. OF UN TS 2, b() EW CONSTRUCTION
( ) COMMERCIAL/INDUSTRI L ) � ( ) EXISTING STRUCTURE
( ) TENANT IMPROVEMENT TOTAL AREA OF PROPERTY I I(Si -I- SQ. FT. •
IMPERVIOUS SURFACE_ h216 SQ. FT. •
)X 9 PLUMBING FIXTURES (Including rough-ins) • MECHANICAL APPLIANCES
PLEASE USE THE ATTACHED P_UMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SYSTEMS, HEATING AND AIR UVITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAWN SPRINKLER SYSTEMS, B,\CK FLOW PREVENTERS, ET AL
If
IX 10 Water Service meter size if known) Also see BOX 4
X 11 Septic Tank-Not generall, allowed in the City of Spokane Valley. For special circumstances contact
Your sewer purveyor and t e Health District (See BOX 4)
X 12 Street use may require a " treet Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
Works Department.
-RIFY UNDER THE PENALTY OF PE-JURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND •
RRECT TO THE BEST OF MY KNOW EDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
JVE PREMISES TO PERFORM THE ORK FOR WHICH THE APPLICATION IS MADE.
,��,,..aatt
'NER I AGENT 21-11/k/\- • 4� r4`�'Ut DATE q-2_4--03
(M/FRl
•
I hereby authorize the City of Spokane Valleyto
I c urge the,fee for this permit to my credit card:
Visa Mastercan. 2
7a' •--
Print the name of the Folder 1D i(Z-IL )p
Signature 4111
This document originally co tamed
confidentia'FErlair=crW
was redacted pursuant to RCW 19.255.010 _
OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE --- -- —
and the — 4 ----- ____
pursuant to SOS DAN G52014-030.
—
ZONE SETBACKS: FRONT- SIDE ------____•-___________________________
REAR HEIGHT LIMIT'
•
____�_
PLANNING DEPARTMENT APPROVAL
DISAPPROVAL DATE
REMARKS
•
SEPA: EXEMPT NOT EXEMPT
--------------------------------------
FIRE DEPARTMEN II APPROVAL I DISAPPROVAL DATE
REMARKS
PUBLIC WORKS DEPkDISAPPROVAL
APPROVAL --
• DATE
•
----
TYPE OF JOB: NEW RESIDENCE
RES.ADD/ALT NEW INDUSTRIAL IND.ADD/ALT
NEW COMMERCIAL COMM.COMM.ALT/ADD
NEW MULTIFAMILY NO. UNITS
MULTIFAMILY ADD/ALT TENANT IMP. ROOF
OTHER
OCCUPANCY TYPE OF CONSTRUCTION
STORIES
BUILDING SQ. FT. @ —
BUILDING SQ. FT. @ —
BUILDING SQ. FT. p�
BUILDING SQ. FT. • @p —
TOTAL SQ. FT. TOTAL VALUATION.
BUILDING PERMIT N . PLAN CHECK FEE REC'D
I RECEIPT NUMBER
PERMIT FEE
.PLAN CHECK FEE PLUMBING FEE MECH. FEE
TOTAL FEES ,
WSBCC SURCHARGE ENERGY SURCHARGE
OTHER CHARGES I
AMOUNT DUE
BUILDING DEPARTM,FrNT APPROVAL . BY
DATE .
•
• ASSIGNED ADDRESS •
•
•
i •
,
Sant /r +t~rrti 11707 East Sprague 4venue,Suite 106 . 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
*Valley For Inspections, call 509-688-0054
'Mechanical Permit Application
PROJECT b()'LE x PERMIT
ADDRESS: upciti 11-14 /....m t USE:
OWNER Goof) , M-f -r— SaCi E i PHONE(Daytime Contact): Q 24' _(p i(, I
MAILING ADDRESS: TM••(f'M- Coo Otto 0
111 2-1 E. ' A;UE &P-rt"- t.)frce-4S l WA. 916 Roo
(street) (city/state) (ZIP)
CONTRACTOR: -1-• I/i j� ( LICENSE A: 3',SK t y� OZ9 31
MAILING ADDRESS: 1=-� PHONE S: , — •i\(.,
4665 S. BEST CT, V&-11A- I WA-, Gtro37
(street) (city/state) (ZIP)
DESCRIPTION OF WORK F OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE -OR<100,000 2 X $15 - 30
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 mut 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 INSERT,GAS FIREPLACE - Z X $10 - 20
13 RANGE - Z-. X $10 -
14 DRYER - 2 x $10 - O
15 FUEL BURNING WATER HEATER - Z X $10 - 20
16 MISC FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - (p X $1 - 144'
18 DUCT SYSTEMS - C� X $10 - 21)
19 VENTILATING FANS - X $10 - t
20 AIR HANDLER(DOES NOT include 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 - z X $10 -
25 HEAT PUMP/AIR CONDITIONER 0-3 TON 2_ X $12 - .--:4.2
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: 240
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
-', `` TOTAL PERMIT FEE DUE: 2.15
VISA '
❑ CASH ❑ CHECK ❑ Nig=
❑ L__-_,..7:2-±..._,
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Scrr��>E qt 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
okane Spokane Valley,' 'AT 99206 509-688-0037-Fax
40.00-- Walley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT D l)P t.E X PERMIT
ADDRESS: 11401 E -774 1 Ali USE:
OWNER: (nD 5 1 -r Ste.Evil PHONE(Daytime Contact):
MAILING ADDRESS:
17121 a. ST4 R\J E , 12-ESO AK.PeS i W A, cfg0 4,
(street) (city/state) (ZIP)
CONTRACTOR T, ` ,! 1 k....4.t ID 60 LICENSE#: 0-S K{� -� co Z'J.,7
MAILING ADDRESS: M�- PHONE#: S.l — �3 S4
4b05 S. B.EST C.T. VE Pre , LO q 1037
(street) (city/state) (ZIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 14 x $6 - z4--i-
2 URINALS X $6 -
3 TUBS 2 X $6 - /2
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 2. X $6 - 12_
5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 447 X $6 - 31p
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 - L Z
7 CLOTHES WASHER Z X $6 - lZ
8 GARBAGE DISPOSAL 2, X $6 - I Z
9 WATER SOFTENER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 -
1l 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 Z X $6 - 12.
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND /0 X $6 - ?/
0
R.P.B.P.D.FOR:VATS,TANKS,BOILERS .7�[
17 SPRINKLER SYSTEM 2 X $25 - Jr')
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: 2,1
illnilit I
�faS _ PLUS PROCESSING FEE: $35.00
❑ CASH ❑ CHECK ❑ WM= ❑ _._
TOTAL PERMIT FEE DUE: 25 3
DATE: EXPIRES:
3ANKCARD NUMBER
1UTHORIZED SIGNATURE:
Aoit Call 24 hours before inspection required
coe Phone 509.688-0036 Fax 509.688-0037
Iley
►ok ne
DEPARTMENT OF PUBLIC WORKS
P.
Anticipated start date Permit # PW 9,3 -Z7®
APPROACH PERMIT
APPLICATION
Location of property got?
(Add res arcel #, if available)
Applicant Name\_?5 A;
Address 4/00S & Phone qo9 --(oy1L
Contractor's Name 1---(91,in 1(i
Address Phone 2-q"(0(--(1
Contractor's Reg# 3c ' I RG * mq,j 7 Expires 7
PROJECT DESCRIPTION (Provide site sketch)
Residential Driveway Commercial/Industrial, Driveway
Existing Curb & Gutter Rural Road Section
Culvert Installation Sidewalk Repair/Construction
Other conditions
See construction requirements and details on reverse. Bond/insurance certification must be on
file with the City.
SPECIAL CONDITIONS: Z d.rZv .�.,. _rr`Ez, , ,., Ly
0
PERMIT FEE $ E-95170 X o = 5e2Inspection Fee$
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 Signature
Fees Paid$ r%y ., Date !nit
11 .1Zt
APPROVED B -"�
A
1lol 12,
1161
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Lor 141 BLOL►G. Z ‘xyczANI�
SEG'rtot.4 ZL-, T, 25 11,
VikLL t/ 12,th&E P,U,D, 82,041
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