2004, 09-07 Permit App: BLD-04-07504 Residence 00.1°\414•441 BUILDING PERMIT APPLICATION WORKSHEET
swam City of Spokane Valley Community Development Department
Building Division
11707 E. Sprague Avenue, Suite 106
.00017all
evSpokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE I ri.• �' hafid E 1
Street Address: 1 6 . 1 S 6 QI `t- Llti� SEP 0 7 2004
Assessor's Tax Parcel Number(s): 39� U1111. 00413
Legal Description: `T 4 6L, k S c )--16/1e,ycJ4ke IciAto ' /r4
PERMIT DESCRIPTION: ea 1 CieMe.t
'uilding PermitChan
❑ Relocation ❑ Change in Use El Grading ❑ Manufactured Home
ElTenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner:
❑ Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
21/
Contractor: (.,& 1 FF Sc 1TZe.0,01
Phone: ' ' '_7 Y Fax: U Architect:
i -9.� '7 Phone: Fax:
Address: 1 SZ0 . S EGRe: 4.r. Address:
wY 9903'7
City State Zip Code City State Zip Code
WA State Contractor License #: CL /FISC,/01/el€ontact: e4g 99q- 77 33
PERMIT/BUILDING INFORMATION •
HEIGHT TO PEAK: DIM�COIONS;xv #OF DORIES:
MAIN FLOOR TO SQ. FTG: 2rFLOOQR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASE EN SQ. FTG: GARAGE SQ. FTG: DECK/C V. PATIO SQ. FTG:
IyL/ ,�-
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
6
#OF BEDROOMS:` � • TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
z5 S ^--
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITESEPTIC
•O SYSTEM?
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
El BOLTING El CONCRETE El 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 ❑ Mastercard 0 VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
MECHANICAL PERMIT APPLICATION
1)0-Kane City of Spokane Valley Community Development Department
BuildingDivision
��� 11707 E. Sprague Avenue, Suite 106
.00/ValSpokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: � (pz. t $ S '0 Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
D lite M L City State Zip Code
Contractor. 'Tf�t Iii HattIf't/G 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 Mare 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 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 3 X $1.00 =
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS 3 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 I $25.00 =
METHOD OF PAYMENT: SUBTOTAL
D CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE: I
AUTHORIZED SIGNATURE:
SCITY PLUMBING PERMIT APPLICATION
City of Spokane Valley Community Development Department
BuildingDivision
ley 11707 E. Sprague Avenue, Suite 106
40,Val
e Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: 0-11M Mt-" S P Ltd len el 3 (. License#: Phone#:
Mailing Address: •
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =-
4
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD.
PREP/CULINARY/MEAT
6 DISHWASHER / X $6.00 =
7 CLOTHES WASHER ) X $6.00 =
8 GARBAGE DISPOSAL ' X $6.00 =
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, 1 X $6.00 =
CONDENSATE I
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 =
VENT, PLUMBING.REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR ; GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, 3 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 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH El CHECK ❑ VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
a
This she plan is being submitted for the purpose of
•
i1 obtaining a building permit and is a true and correct
ADDRESS L— .i• representation of the . ..• . AM known property
ZONE ...► lines/dimensions,curb I . , - . and easements
ROAD WIOTh v' , have been Id nti . 4f, - •„_;_• are wetlands.
FRONT F i 4 •
COMMENTS-, / !, Signed:af�..r/,� / critical areas.
REVIEWED = -®
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