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2005, 08-04 Permit App: 05002739 Residence
Project Number: 05002739 Inv: 1 Application Date: 08/04/2005 Page 1 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: NEW RESIDENCE W/GARAGE-GAS Contact: LEBEDINSKI,SERGEY&OLGA Address: 14415 N FORKER RD C-S-Z: SPOKANE,WA 99217 Setbacks: Front 20 Left: 20 Right: 40 Rear: 29 Phone: (509)991-8631 Group Name: Site Information: Project Name: ROW Plat Key: Name: UNIVERSITY PLACE District: Sout Parcel Number: 45204.0811 Block: Lot: SiteAddress: 9922 E 9TH AVE Owner:Name: LEBEDINSKI,SERGEY&OLGA Address: 14415 N FORKER RD Location::CSV SPOKANE,WA 99217 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: .17 Acres Width: 100 Depth: 75 Right Of Way(ft): 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: Review Site Plan Review Released By:4,L GIVEN TO PLANNING 8/4 Plan Review Released By: Originally Released: 07/20/2005 By: TMELBOU Approach/Drainage Released By: Originally Released: 08/04/2005 By: cjjanssen Sewer Review Released By: Permits: Operator: CJJ Printed By: CJJ Print Date: 08/04/2005 Project Number: 05002739 Inv: 2 Application Date: 08/31/2005 Page 1 of 3 • THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Project Information: Permit Use: NEW RESIDENCE W/GARAGE-GAS Contact: LEBEDINSKI,SERGEY& OLGA Address: 14415 N FORKER RD C-S-Z: SPOKANE,WA 99217 Setbacks: Front 20 Left: 20 Right: 40 Rear: 29 Phone: (509)991-8631 Group Name: Project Name: ROW Site Information , oormr/ -,14,ff ,.>,.;. seaa,,,...- ... .,.,..,�, .._. Plat Key: Name: UNIVERSITY PLACE District: Sout Parcel Number: 45204.0811 Block: Lot: SiteAddress: 9922 E 9TH AVE Owner:Name: LEBEDINSKI,SERGEY&OLGA Address: 14415 N FORKER RD Location::CSV SPOKANE,WA 99217 Zoning: UR-3.5 Urban Residential 3.5 Water District: Hold: ❑ Area: .17 Acres Width: 100 Depth: 75 Right Of Way(ft): 40 Nbr of Bldgs: 1 Nbr of Dwellings: 1 Review Information: '‘VP.::';'. ,01 W im..,, ,,,. ck OAM A.WJ ;y , ,r ,, WI ,A.5. s....;....a Review Site Plan ReviewReleased B GIVEN TO PLANNING 8/4 Originally Released: 08/04/2005 By: HKAUER Plan Review Released By: Originally Released: 07/20/2005 By: TMELBOU Approach/Drainage Released Bye Originally Released: 08/04/2005 By: cjjanssen Sewer Review Released By: Originally Released: 08/08/2005 By: kjkurtz Operator: CJJ Printed By: KJK Print Date: 08/31/2005 Project Number: 05002739 Inv: 1 Application Date: 08/04/2005 Page 2 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Approach Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Item Description Units Unit Desc Fee Amount APPROACH INSPECTION 1 NUMBER OF $25.00 CONST IN ROW-APPROACH 1 NUMBER OF $25.00 Permit Total Fees: $50.00 Building Permit Contractor: OWNER Finn: OWNER Phone: (000)000-0000 Building Characteristics Total Area 1040 Building Height 24 Stories 2 Dwelling Units 1 This Application: Total Project: Description Grp Type Notes Su Ft Valuation Su Ft Valuation BASEMENT U R-3 VB 264 $3,960.00 264 $3,960.00 GARAGE U-1 VB 487 $9,253.00 487 $9,253.00 RESIDENCE R-3 VB 1,040 $77,667.20 1,040 $77,667.20 Totals: 1,791 $90,880.20 1,791 $90,880.20 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $930.75 STATE SURCHARGE 1 SELECT $4.50 Permit Total Fees: $935.25 Operator: CJJ Printed By: CJJ Print Date: 08/04/2005 Project Number: 05002739 Inv: 2 Application Date: 08/31/2005 Page 2 of 3 . THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Permits: , W,,, ai, ...M., ,.sj, e� Mc,S, ZAZWN ,; , sr ,,SSW ESR-x,',U x::; — Approach = Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Building Permit Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Building Characteristics Total Area 1040 Building Height 24 Stories 2 Dwelling Units 1 This Application: Total Project: Description Grp Type Notes Sq Ft Valuation Sq Ft Valuation BASEMENT U R-3 VB 216 $3,240.00 480 $7,200.00 GARAGE U-1 VB 487 $9,253.00 RESIDENCE R-3 VB 222 $16,578.96 1,262 $94,246.16 Totals: 438 $19,818.96 2,229 $110,699.16 Item Description Units Unit Desc Fee Amount RESIDENTIAL PERMIT FEE 1 SELECT $99.60 STATE SURCHARGE 1 SELECT $4.50 RESIDENTIAL PLAN REVIEW 1 SELECT $39.84 Permit Total Fees: $143.94 Mechanical Permit Contractor: OWNER Firm: OWNER Phone: (000)000-0000 -- Plumbing Permit Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Operator: CJJ Printed By: KJK Print Date: 08/31/2005 Project Number: 05002739 Inv: 2 Application Date: 08/31/2005 Page 3 of 3 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: .: . . .CA., , ..M,. ,ti, M. .. ,M.I MMONMVXMIr ,;IMM :: ,-ZIMW FAI,_. = Payment Summary: , .,m z- mmomx; 7= , Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Building Permit $143.94 $143.94 $0.00 $143.94 $143.94 $143.94 $0.00 $143.94 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: CJJ Printed By: KJK Print Date: 08/31/2005 Project Number: 05002739 Inv: 1 Application Date: 08/04/2005 Page 3 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Mechanical Permit Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Item Description Units Unit Desc Fee Amount DUCT SYSTEMS 1 NUMBER OF $10.00 GAS WATER HEATER 1 NUMBER OF $10.00 GAS APPLIANCE>100,000BTU 1 NUMBER OF $15.00 GAS PIPING 2 #OF UNITS $2.00 AIR CONDITIONER:4-15 TONS 1 NUMBER OF $20.00 VENTILATING FANS 3 NUMBER OF $30.00 CLOTHES DRYER 1 NUMBER OF $10.00 AIR HANDLER<=10,000 CFM 1 NUMBER OF $12.00 HOOD-TYPE II 1 NUMBER OF $10.00 VENTILATION SYSTEM 1 NUMBER OF $12.00 VENTILATION MECH EXHAUST 1 NUMBER OF $12.00 Permit Total Fees: $143.00 Plumbing Permit Contractor: OWNER Firm: OWNER Phone: (000)000-0000 Item Description Units Unit Desc Fee Amount TOILETS/BIDETS 2 NUMBER OF $12.00 SINKS 3 NUMBER OF $18.00 SHOWERS 1 NUMBER OF $6.00 TUBS 1 NUMBER OF $6.00 DISH WASHERS 1 NUMBER OF $6.00 GARBAGE DISPOSAL 1 NUMBER OF $6.00 CLOTHES WASHER 1 NUMBER OF $6.00 FLOOR DRAINS 1 NUMBER OF $6.00 WATER USING DEVICES 3 NUMBER OF $18.00 Permit Total Fees: $84.00 Operator: CJJ Printed By: CJJ Print Date: 08/04/2005 Project Number: 05002739 Inv: 1 Application Date: 08/04/2005 Page 4 of 4 THIS IS NOT A PERMIT Penalties will be assessed for commencing work without a permit Notes: Payment Summary: Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing Approach $50.00 $50.00 $0.00 $50.00 Building Permit $935.25 $935.25 $0.00 $935.25 Mechanical Permit $143.00 $143.00 $0.00 $143.00 Plumbing Permit $84.00 $84.00 $0.00 $84.00 $1,212.25 $1,212.25 $0.00 $1,212.25 Disclaimer: Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the provisions of the code or of any other state or local laws or ordinances. Signature: Operator: CJJ Printed By: CJJ Print Date: 08/04/2005 2-q3 r � Q0--*:)BUILDING PERMIT APPLICATION WORKSHEET - City of Spokane Valley Community Development Department po� .ne ! 2') Building Division I it=-.. 11707 E. Sprague Avenue, Suite 106 do, A al ao, Spokane Valley, WA 99206 Phone: (509) 688-0036; Fax: (509) 688-0037 I i DgI NFORMATION p I UI;1' � Street Address: e'LL p •oka.rm VaterywA e90106 Assessor's Tax Parcel Number(s): 1/5 d Oi. 9 8// Legal Description: 75 1 / f x ,e) Y , kill yelp s,` Pea ez- PERMIT DESCRIPTION: ® Building Permit ❑ Change in Use El Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other OWNER/APPLICANT INFORMATION ❑ OwnenSei ,eco. lit I�-hdZyL ❑ Applicant: C jp,RPhone: 46` y7 &63/ Phone: 1165 L/7S/ Fax: Address: /4' J 5ii/ /04,04)/04,04) -,Qj Address:/y105 /1/ Fopke/z Ad cp()kaM Wil- 99A/7 Ci State Zip Code City State Zip Code ❑ Contractor: 0V/fie/lc' ❑ Architect ,edeo} /%mP pec 5 Phone: Fax: Phonery56) 75/5) Fax: Address: Address: s/ t- f i .2,0ke_ WA- City State Zip Code City State Zip Code • WA State Contractor License#: Contact: Spokane Valley Bus. Liscense#: Contact: PERMIT/BUILDING INFORMATION r HEIGHT TO PEAK: y , DIMENSIONS: //0 X 2�- #OF STORIES: MAIN FLOOR TO SQ. FTG: 6v 4 0 2""FLOOR SQ. FIG: UNFIN BASEMENT SQ. FT FINISHED BASEMENT SQ. FTG: GARAGE GARAGE SQ. FTG: 0.7 DECK/COV. PATIO SQ. FTG: BU 5 OCCUPANCY GROUP: O TRUCTIOe TYPE: sr/('4 e f HEAT SOURCE: ,,. S i hyo�2 hints �am #OF sire 3 TOTAL HABITABLE SPACE://33 PACE//33 5f IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30%SLOPES ON PROPERTY SEWER OR ON-SITE SEPTIC NO SYSTEM? ilo � BUILDING PERMIT APPLICATION WORKSHEET _ City of Spokane Valley Community Development Departmeni .Spa 3 Building Division �+ 4:1707 E. Sprague Avenue, Suite 105 " . . -_,...--0.-- a e Spokane Valley, WA 99200 9 883-0036; Fax (509) 688-0+037 ' , E I'NPOR I _ . " It.au- [1 WI € �1 Street Address: 7 9g 2 C 7 T# A V D 3 rif*s Assessor's Tax Parcel Number(s): D U 1T)) ii hl Legal Description: \\ PERMIT DESCRIPTION: c.G ee,, S r) 5 3 ❑ Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home ❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other N OWNER/APPLICANT INFORMATION LA ' 'le"C ❑ Applicant:1) pp _Owner. �/,tC.Q C Phone: 7,?'/232 Fax: Phone: Fax: Address: / Z© f:3•pi Z ') Avs Address: 5Po.eae/49t e1 14/4 772/4 City State Zip Co City State Zip Code ❑ Contractor. ❑ Architect: Phone: Fax: Phone: Fax: Address: Address: City State Zip Code City State Zp Code • WA State Contractor License#: Contact: Spokane Valley Bus. Liscense #: Contact: Il PERMIT/BUILDING INFORMATION HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: MAIN FLOOR TO SQ. FTG: 2"u FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG: FINISHED BASEMENT SQ. FTG: GARAGE SQ.FTG: DECK%GOV. PATIO SQ. FTG: OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: #OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA: COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC SYSTEM? iloiliontia At 4 � 5 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: 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 Signature Method of Payment: (Faxed permit applications will only be accepted with major bankcard) ❑ Cash ❑ Check 0 Mastercard ❑ VISA ❑ Other Bankcard#: Expires: VIN#: Authorized Signature: PLUMBING PERMIT APPLICATION Community Development Department war Building Division ne Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106 For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206 g m1I ve Project Address: qq a.. [ >` ?Okai71 Vgelet1 wA Permit Use: Owner .5'el,1 I a v J &diff Phone(Daytime Contact): Mailing Address: // io--- /fOA'kei ki pokame WI 99,'/7 City State .Zip Code Contractor. License#: Phone#: Mailing Address: City State Zip Code DESCRIPTION OF WORK #OFqeUNITS X COST = TOTAL AMOUNT pL 1 TOILETS WATER CLOSET,BIDETS X $6.00 = I d 2 URINALS — X $6.00 = 3 TUBS / X $6.00 = 6 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6.00 = 6 LAVS/BASINS,BAR,FLOOR,KITCHEN, 5 SINKS LAUNDRY,UTILITY,JANITOR PHOTO, 3 X $6.0D = /OD X-RAY,FOOD,PREP/CULINARY MEAT 6 DISHWASHER / X $6.00 = ,i . 7 CLOTHES WASHER / X $6.00 = (? 8 GARBAGE DISPOSAL / X $6.00 = 6 9 WATER SOFTENER X $6.00 = 10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL y X $6.00 = 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE / X $6.00 = ROOF DRAINS/OVERFLOW 12 DRAINS X $6.00 = 13 FOUNTAINS,DRINKING X $6.00 = WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR, 14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 = 15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.DD = ICE AN/OR COFFEE MAKER,HOSE BIB, 16 WATER USING DEVICE STEAMER 3 X $6.00 = PROOFER,CARBONATOR,SWAMP COOLER VACUUM BREAKER,CHECK VALVE, 17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 = GREASE TRAP,SAND TRAP, 18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 = 19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 = MISCELLANEOUS PLUMBING 20 FIXTURE X $6.00 = 21 PRIVATE SEWAGE DISPOSAUSYS X $20.00 = INDUSTRIAL WASTE 22 INTERCEPTOR X $15.00 = SUBTOTAL METHOD OF PAYMENT: PROCESSING FEE 0 CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00 DATE: EXPIRES: TOTAL PERMIT FEE DUE: BANKCARD NUMBER: AUTHORIZED SIGNATURE: MECHANICAL PERMIT APPLICATION Community Development Department Building Division cl1ky Phone: (509) 688-0036; FAX: (509),688-0037 11707 E. Sprague Avenue, Suite 106 , ,f For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206 Project Address: i-/01,, E spoke t/€2,1441, WA 9t9„W6 Permit Use: Owner. 5Qili / BSL Z2 edti /, 7 Phone (Daytime Contact): Mailing Address: /4/1 /s A( F,ylti,4 Rd £p0A'a ne City WA- stat4g� /7 Zip Code Contractor..9t License#: Phone#: Mailing Address: City State Zip Code DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT 1 FUEL BURNING APPLIANCE Equal to or less than 100,000 X $12.00 = 2 FUEL BURNING APPLIANCE More than 100,000 / X $15.00 = 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 = 5 USED APPLIANCE(WSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 = 6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 = 7 BOILER/REFRIGERATION 1-100M BTU X $12.00 = 8 BOILER/REFRIGERATION 101-500M BTU X $20.00 = 9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 = 10 BOILER/REFRIGERATION 1,001-1,750M BTU X $35.00 = 11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 = 12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 = 13 RANGE X $10.00 = 14 DRYER I X $10.00 = 15 FUEL BURNING WATER HEATER / X $10.00 = 16 MISC.FUEL BURNING APPLIANCEX $10.00 = _ 17 GAS PIPING feach outlet) ii X $1.00 = 18 DUCT SYSTEMS / X $10.00 = _ 19 VENTILATING FANS X $10.00 = 20 , AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM 1 X $12.00 = 21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $15.00 = 22 EVAPORATIVE COOLERSX $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 I 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 = 33 REPAIR&ADDITIONS X $15.00 = 34 VENTILATION SYSTEMS• , X $12.00 = 35 VENTILATION MECHANICAL EXHAUST I X $12.00 = 36 INCINERATOR-RESIDENCE X $19.00 = 37 INCINERATOR-COMMERCIAL X $22.00 = METHOD OF PAYMENT: SUBTOTAL 0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00 CARD#: EXPIRES: TOTAL PERMIT FEE DUE: AUTHORIZED SIGNATURE: P 100 1 c R F_ Sw kaM e Va eeay. 41-‘ ve )(I �fl y0 't p,icto , ic,,,,z• 9q,e2 F 9 '/t'e Ofra op ,Ii , U '�l,a 4ysp "'P a4lo ,se � -... .... ...........4-'"--"--;'). d /o a,ioo 4,,011470u•s'o,n 'tau, 0% SO°, P ani J> /, lJ")l1S S sit aa/ •a/p0 • '0)69(,1 r) ay1,o{p.1>ti i ocy !Oar,Uople 10 sa po6•iS ce •s 7.5�1 9n7 6 a4`"pn„9°j/e,1e4pisa,.6y p/d a1 I alis Sir90 •yl I 1 : j I y i I I (1_ 1%"!^ ti j I I •<3j 7, i i Ili.L._-----.._ PLANNING DEPT. APPROVED - BY• __ - - -l/am � DATE: g SV DSv v as/GS