2003, 08-07 Permit App: BLD-03-02168 Residence CC(!SpokaneN144, ,
40,Va"ley
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
IREQUIRED SITE INFORMATION
STREET ADDRESS: L(CI6 V��
ASSESSOR'S TAX PARCEL NUMBER(S): L\52:51, 11
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: r\3 J ) . L .
RIDING PERMIT 0 CHANGE IN USE -a GRADING C MANUFACTURED HOME
0-RELOCATION 0-SIGN 0-TENANT 0-OTHER.
I OWNER / APPLICANT INFORMATION
1
® OWNER: -/�,SZI-Oi I-'>C ® APPLICANT:
PHONE: 6126-L24, �AX: S' 2,--02,7,-1\ PHONE: L FAX:
ADDRESS: i-461,1 S S . I h Or- htL, C yf-(,U31 ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: J-11 0 ARCHITECT:
' v
PHONE: FAX: PHONE: FAX:
ADDRESS: ,-f i 'f,! 1 ' ADDRESS:
( �- b(d 5 t.
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# T\51 ,1 0-1 L.\ CONTACT: CS�-P
IPERMIT/BUILDING INFORMATION l
COST OF PROJECT: I CoA OCC) 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 13} Z
BUILDING HEIGHT TO PEAK: (v OCCUPANCY GROUP: `� 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: (✓O-r' i CONSTRUCTION TYPE: (SC UNFIN BASEMENT: 1 Z-1;
'NUMBER OF STORIES: 1 STRUCTURES ON PROPERTY: FINISHED BASEMENT: ..-----
NUMBER
JNUMBER of BEDROOMS: 3 CRITICAL AREAS: .. GARAGE: LI 51
FLANKING SETBACK: CURRENT PROPERTY SIZE: Z 'S�' `� COVERED DECK: 10 0
(� f,
FRONT SETBACK: Civ CURRENT PROPERTY USE: DECK: cfv. CJ
REAR SETBACK: ZA CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE: /
RIGHT SETBACK: IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME r SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT Or SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: .. TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
T
® BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ®COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 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: 0 YES 0 NO PSSA: 0 YES 0 NO
IDATE: 1 STAFF:
METHOD OF PAYMENT:
® ® ® rt- 0
h',ZSk4:gCarti! WSA
CASH CHECK sure
BANKCARD Ii; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
AUG 04 2003 16 14 FR TO 3241567 P.02/03
11707-5;s-tSprague A-ve Ste 1Or-i-/ /' ,, Q�
Spokane Valley, WA 99206, oC LS/ U
Phone: 50.9 688.0036 Fax:(509)688.0037
REQUIRED SITE INFORMATION
STREET ADDRESS: 6
ASSESSOR'S TAX PARCEL NUMBER(S): \523), '1E1'06
- —
LEGAL DISCRIPTION:
PERMIT DESCRIPTION.: _. lf� .,� .H t,
_-
: r .. -PERMIT •CI-CHANGE-Ii-YTSE •liCkADINo U M FACED ROM
a MOCk11011 -- 0-SIGN v m R.. '
QWNER / APPLICANT INFORMATION
®OWNER: �l �^' APPLICANT:
PHONE: 4V113'1--`2:1 AX: 2 i?OZl1 PHONE: FAX:_
ADDRESS: 1.402A J . t thgAr)P4 -, t231 ADDRESS:
CITY,STATE,ZIP - CITY,STATE,ZIP
°CONTRACTOR: ARCHITECT:
PHONE: PAX: - PHONE:
FAX:
ADDRESS: ADDRESS:
CITY,•STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# tbtrr�� ltd . CONTACT:
APPROVALS
BUILDINGS: •
- -
4-
L
PLANNING: -
ENGINEERS:
Rump , Jc ltt.. :- $-a3 Fon — ; o c.c w• ,^,,r• Sevni,,L
SEWERt . - ....
IRE DIS s • _ - ---
LUILUNVV L!/VI.J/UN rjL O 0 3
11707 East Sprague Ave Ste 106 r r
\Spokane Valley, WA 99206. ..• I (
Phone:(509)688-0036 Fax:(5099688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: L-6 6 V~
ASSESSOR'S TAX PARCEL NUMBER(S): 'l 525)%
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: V\.) ,
IJL.DING PERMIT • ].CHANGE IN USE .01 GRADI2sr.G 0 MANTIEACTURED HOME
El-RELOCATION 0-SIGN Et TENANT 0-OTHER
•
OWNER / APPLICANT INFORMATION
•
® OWNER: 5-0 N. - fN't A u-'`-- 0 APPLICANT:
PHONE: . LC9--L21, AX: i� \2,'OZ7,1 PHONE: L . FAX:
,
ADDRESS: 1d 5 A V 2PAJ 'LE (-4/ 31 ADDRESS:
CITY,STATE,ZIP .• CITY,STATE,ZIP
® •CONTRACTOR: �"� x • 0 ARCHITECT.:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP , J� CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# �\S Dv�O Lo CONTACT: k.. .. ''Q 1
APPROVALS
BUILDINGS: • - .
•
•
PLANNING:
ENGINEERS: RC� C3-• 47 -) ,
: 21\A-- —i ,2)--m
AF.AL�TH'. J(
SEWS :
DISTs •
cr1i
. a rt
ley
MECHANICAL PERMIT APPLICATION
PROJECT �,� PERMIT
ADDRESS: liMe`1 Il Q USE:
OWNER: SS b 1_3
1 f� ` �
AA , PHONE(Daytime Contact): `-)U
MAILING ADDRESS: 9�q,.'
(street) (city/state) •(zip)
CONTRACTOR: LICENSE#:
0 kOtIA E\ ,SIG -,
MAILING ADDRESS. PHONE#:
(street) (city/state) (zip)
DESCRIPTION OF WORK #OF UNITS x COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 1 X $15 =
2 FUEL BURNING APPLIANCE >100,000 X $19 =
3 UNLISTED APPLIANCE(ADDITIONAL FEE) =0R<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 INSERT,GAS FIREPLACE - X $10 =
13 RANGE - / X , $10
14 DRYER - % X $10 =
15 FUEL BURNING WATER HEATER - I X $10 =
16 MISCELLANEOUS FUEL BURNING APPL - X $10 -
=
17 GAS PIPING(ea.Outlet) - S X $1 =
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - 3 X $10 =
20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 =
21 AIR HANDLER(DOES NOT Include ducting) >10,000CFM X $19 =
22 EVAPORATIVE COOLERS - X $10 =
23 TYPE I HOOD - I X $50 =
24 TYPE II HOOD - X $10 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON 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 +50TON X $60 =
30 LPG STORAGE TANK - X $10 =
31 WOOD OR PELLET STOVE/INSERT - X , $10 =
32 WOOD STOVE-FREE STANDING - X $25 . =
SUBTOTAL
: t.
0 CASH 0 CHECK 0 MEM 0 -= PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OF A MAJOR CREDIT cARD FEE
TOTAL PERMIT FEE
DATE: EXPIRES: ,
DUE
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
aTr of ;Trp
Po .
'V .].ey
• PLUMBING PERMIT APPLICATION
PROJECT s "�, PERMIT,
ADDRESS: 1'[} j USE: �` `' `iSi AL
OWNER: �'S S [Y,�t LIAM 1 SNC, PHONE(Daytime Contact): q 39-1610
MAILING ADDRESS: L1 a•iq s 'f vaD� ��jE1 A,ALG P1 9`Vci
" (street) (city/state) (zip)
CONTRACTOR: LICENSE#:
bt-L3 6.0L- % 0AN-140
MAILING ADDRESS: PHONE#:
(street) (city/state) (zip)
•
PLUMING'FIXTURES
DESCRIPTION DETAILS #OF UNITS x COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 in .
2 URINALS • X $6 =
3 TUBS 2. X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6 =
5 SINKS LAVS/BASINS,BAR,FLOOR, X $6
KITCHEN,LAUNDRY,UTILITY,
JANITOR,PHOTO,X-RAY,FOOD, " •
PREP/CULINARY/MEAT =
6 DISHWASHER I X $6 =
7 CLOTHES WASHER I X $6 =
8 GARBAGE DISPOSAL I X $6 =
9 WATER SOFTENER X $6 =
10 ELEC HOT WATER TANK NOTE:IF GAS SEE I#IECHANICAL X $6 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, $6
CONDENSATE I X =
12 FOUNTAINS,DRINKING X $6 =
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION, X $6
WASTE,VENT, REPAIR,REVERSALS
PLUMBING REVERSAL =
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 =
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER, X $6
HOSE BIB,STEAMER,PROOFER,
CARBONATOR,SWAMP COOLER
3 =
16 CROSS CONNECTION VACUUM BREAKER,CHECK • X $6
DEVICE VALVE,AND R.P.B.P.D.FOR:
VATS,SUMPS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25
18 INTERCEPTORS GREASE TRAP,SAND TRAP, $6
CHEMICAL HOLDING TANK X
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC PLUMBING FIXTURE X $6 = —
- •— SUBTOTAL
vim . .
❑ CASH p CHECK ❑ .= 0 PLUS PROCESSING
FAXED PERMITS WILL ONLY BE ACCEPTED WITH PAYMENT $35.00
OF A MAJOR CREDIT CARD FEE
TOTAL PERMIT FEE
• DUE
DATE: EXPIRES: .
BANKCARD NUMBER: •
AUTHORIZED SIGNATURE:
•
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