2004, 06-30 Permit App: BLD-04-04808 Residence BUI ►I 'ERMIT APPLICATION WORKSHEET
SIAM
City Of Spokane' alley P.mmunity Development Department
Building Division
C N 11 '07 E. Sprague Avenue, Suite 106
4000 , ' Spokane Valley, WA 99206
ev Phone: (509) 688-4436;Eax: (549) 688-0037
REQUIRED -ATE 4 FORMATION
Street Address: I q00. Cr E - t
q q D
Assessor's Tax Parcel Number(s): LES 13'2_ 9 IS�- 04$
-
Legal Description: Li z5- PI Ti " FS" be- S.P. CO -125
Ot\i'
PERMIT DESCRIPTION: 4--10--t- e-
0/Building
--I St'[Building Permit El Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safe O Fgleir W E --
OWNER/APPLICANT INFORMAT ' 2004
0
EV Owner: Ps-G4 rti rL- 1,1va,o t\ -c (LC l ApplicantO ,i L9 0,. N
Phone:cc,ti -` a-'l9o' Fax: ,-SzZ-345 Phone: -7-8c% - Fax:
Address: /% 'oK Ss-3 Address: /K8'/ e Sh
L T-60t ry L-ieil ova 5 g O i`j : SitKr,. ai ai z 11,
City State Zip Code City State Zip Code
❑' Contractor: J-f-- / 'x= aa--1,e V 1 Cu. ❑ Architect: �v
Phone:5-i, -t('-8-Was Fax: S'o5-5zz--g256 Phone: Fax: 4)
Address: 19, x gS3 • Address: 4'VS
LrWri Cie' IA45 vt C ,' rC. ( D
City I State Zip Code City State . ` ' � '�%
G Q�J
WA State Contractor License #: �--I T61-I/t 0L ` 6 z 1.3 Contact: - � t),i t;4.
�� ,�o �` .
/ OJ
PERMIT/BUILDING INFORMATION '� �, � '
HEIGHT TO PEAK n-
DIMENSIONS: �, , r #OF STORIES:
MAIN FLOOR TO SQ. FTG: I�pO 2""'FLOOR SQ. FTG: ' UNFIN BASEMENT SQ. FTG: i
FINISHED BASEMENTS . FTG:
Q � GARAGE SQ. FIG: DECK/COV. PATIO SQ. FTG:
A 4-00 100
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
Tnt)-� t l.00L
#OF BEDROOMS: . TOTAL HABITABLE SPACE: Dv . IMPERVIOUS SURFACE'AREA:
COST OF PROJECT: oG C3 30%SLOPES ON PROPERTY: j SEWER OR ON-SITE SEPTIC
fut
Nr' SYSTEM? 0 i•-) -�L- �E;�-r1L.
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:
nspector(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 aermit inure tex e property owner.
Print Name � G. Signature
Method of Payment: (Faxed permit applications will only • - - -. ed with major bankcard)
❑ Cash ❑ Check 0 Mastercard
❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
•
PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
SI'plane BuildingDivision
ley11707 E. Sprague Avenue, Suite 106
SpokaneValley, 99206
4,000- Val
Phone: (509)688-0036;;Fax: (509))688-0037 688-0037
FOR INSPEFTIONS, CALL(509)688-0054
Project Address: N Oct S C_ tl Permit Use: O1_ St,
Owner: Iti4,--- vatwit-el"' LLL Phone (Daytime Contact): E.('t -( 0 S
Mailing Address: PD T'o'e ')52) LC-brit-1 LAI Lc" CAAA- s 0 1 q
City I State Zip Code
Contractor: DAuC-4 License#: 0TG-ra1•°'-562 L 3 Phone#: gc S Lifts-
Mailing
iftSMailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST • AMOUNT
1 TOILETS WATER CLOSET,BIDETS L X $6.00 = (2`(°,
2 URINALS X S6.00
3 TUBS ,X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 2- X $6.00 = 1?-vv
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 = /U •aO
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER I X $6.00 = C 'toy:
7 CLOTHES WASHER ( _X $6.00 = Co 'w
•8 GARBAGE DISPOSAL I X $6 00 = ,1-2(.),1-2(.)-
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, i X $6.00 = .u
CONDENSATE I
12 ROOF DRAINS/OVERFLOW DRAINS , X $6.00
13 FOUNTAINS,DRINKINGX $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 BB,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 = i-
METHOD OF PAYMENT: SUBTOTAL / C,.txv
0 CASH 0 CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE: ( 0( .o v
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
MECHANICAL PERMIT APPLICATION
Spot City of Spokane Valley Community Development Department
BuildingDivision
\iii.1Je37 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: I4f DOS E- tag Permit Use: 4-- ..-
Owner: -Hr2G-14 Ike vl.ilaso- i LLC. Phone(Daytime Contact): M,t)- 4'9lS
Mailing Address: fo t3�yc gc- 1--b t'1 LA1Li (�m- 9q o i It
Olty State Zip Code
Contractor: A Oma,-.Ye11 License#: 4 M DL`16'1 L'S Phone* pk,i5Li qo S
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORKUNITS 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 =
F
13 RANGE I X $10.00 = b) 'u�
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER 2- X $10.00 = LD 'ys3
16 MISC.FUEL BURNING APPLIANCEX $10.00 =
- 17 GAS PIPING(each outlet) 3 X , $1.00 = 3.��
18 DUCT SYSTEMS I X $10.00 = to •o C,
19 VENTILATING FANS `I X $10.00 =
e .c0
20 AIR HANDLER(DOES NOT indude ducting) Equal to or less than 10,000 CFM I X $12.00 = 12- -0-1
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 I X $12.00 = 12-OC'
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 t OR .v o
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE tt $35.00
CARD# V
: EXPIRES: TOTAL PERMIT FEE DUE: t 1 Z. -00
AUTHORIZED SIGNATURE:
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License Information
License HIGHMDL962L3
Licensee Name HIGHMARK DEVELOPMENTS LLC
Licensee Type CONSTRUCTION CONTRACTOR
UBI 602389544 Verify Contractor Premium Status
Ind. Ins. Account Id
Business Type LIMITED LIABILITY COMPANY
Address 1 13811 E 5TH CT
Address 2
City SPOKANE
County SPOKANE
State WA
Zip 99216
Phone 5098684905
Status ACTIVE
Specialty 1 GENERAL
Specialty 2 UNUSED
Effective Date 6/23/2004
Expiration Date 6/23/2006
Suspend Date
Separation Date
Parent Company
Previous License
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1 Business Owner Information
Name Role Effective Date
;MILLER, WILLIAM PARTNER/MEMBER 06/23/2004
https://fortress.wa.gov/lni/bbip/detail.aspx?License=HIGHMDL962L3 7/8/2004
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GRAY, JEREMY
1PARTNER/MEMBER 06/23/2004 t
k i
9 Bond Information
Bond Bond
g Company Account Effective Expiration Cancel Impaired Bond Received
:Bond Name Number Date Date Date Date Amount Date 1
I#1 CBIC FB7167 06/22/2004 $12,000.00 06/23/2004
w ,– _r ,- ..— r
Savings Information E
No Matching Information
Insurance Information
Company Policy Effective Expiration Cancel Impaired Received
Insurance Name Number Date Date Date Date Amount Date
9 NAUTILUS
#1 INS CO NC321032 06/22/2004 06/22/2005 $1,000,000.00 06/23/2004
[Unsatisfied Summons/Complaints Information
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https://fortress.wa.gov/1ni/bbip/detail.aspx?License=HIGHMDL962L3 7/8/2004
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