2003, 10-08 Permit App: BLD-03-02653 Residence CITY•
sI; , le 1
�' a 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
REQUIRED SITE INFORMATION
STREET ADDRESS: / Z Z- I E L- A fiJ C> {i K � V�. / {' 7Y G
ASSESSOR'S TAX PARCEL NUMBER(S): `d. t
LEGAL DISCRIPTION: L d T L C{ fC 4-1JI e t 'e�/ L4 kQ L I d
PERMIT DESCRIPTION: K e S 3 c o-- r- hit (A-
J1 LDING PERMIT DERANGE IN USE 0 GRADING 0 MANUFACTURED HOME
URELOCATION QSIGN [TENANT E]-Of HER
OWNER / APPLICANT INFORMATION
V OWNER: ( 'e r5 e y l \ L t-te d el c, ® APPLICANT: S A-141
PHONE: 9 L�t �7 7 •5 2. FAX: /2 I 77,, j� PHONE: FAX:
(
ADDRESS: 1' 0 r?)4.)1- 6 '"'4.- Lk_ ( c)FiADDRESS:
CITY, TATE,ZIP CITY,STATE,ZIP
CONTRACTOR: 5(� VIA t:: ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# ec) cri 6 i L) 6.co,l°?6 CONTACT: 1-j( Cy l(“ E-. ✓It�r
PERMIT/BUILDING INFORMATION
COST OF PROJECT: Z�f I �1 30%SLOPES ON PROPERTY: Aid MAIN FLOOR SQ FT: / '/o
BUILDING HEIGHT TO PEAK: I et OCCUPANCY GROUP: R. -5 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 7 ' 6 2. CONSTRUCTION TYPE: V N UNFIN BASEMENT: / 7Ci
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: ND FINISHED BASEMENT:/
NUMBER of BEDROOMS: Z.- CRITICAL AREAS: .1 'LLQ-. GARAGE: -7
FLANKING SETBACK: 2 CURRENT PROPERTY SIZE: J O 0 X70 COVERED DECK: N
r •
FRONT SETBACK: 'Z° CURRENT PROPERTY USE: V/\C I t DECK: J
REAR SETBACK: 3() CURRENT SEPTIC USE: I'J (,)""lk
LEFT SETBACK: P CURRENT WELL USE:
RIGHT SETBACK: /0 IMPERVIOUS SURFACE AREA: AINt .
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
IRELOCATION FIRE SAFETY I
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
IWA STATE NON—RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I
SPECIAL INSPECTIONS I
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
1
IS PUBLIC SEWER AVAILABLE: RYES ® NO IF YES: ® COUNTY E CITY
IS PUBLIC WATER AVAILABLE: YES ® NO IF YES,WHICH WATER DIST/IRR: C'e' ea"
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: I STAFF: ,
METHOD OF PAYMENT.'
0 �f
® ® .:ISA
CASH CHECK L. -- 1
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
an c 1/ �me� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
cry Spokane Valley,WA 99206 509-688-0037-Fax
,,,.Valley
Mechanical Permit Application
PROJECT /6 2.21 c Th 1....6- - PERMIT Ne t,.,..) floes
ADDRESS: S na i, ,119-' I.e(/ W o 95,13- USE: W /3 G 4-1.- 4 T (,
OWNER:r� Y / 4 A X40 ''j� PHONE(Daytime Contact):'q 'IC Er /�
MAILING ADDRESS! 5 a- y
+I° 0 e b e-4r L. + S0 R L I -97.1-2-(street) (city/state) (ZIP)
CONTRACTOR: 5: A.,,,,
LICENSE#: co-- 5 t P
MAILING ADDRESS: PHONE#: 672- 74-
(street) (city/state) (ZIP)
DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 X $15 =
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 min.AFUE rating) =or<400,600 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 = 6 a
13 RANGE - X $10 -
1 b
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - X $10 = / 0
16 MISC FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - X $1 j
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - X $10 = 3 0 ,
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 - I X $10 = t
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 +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: F.•
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
-F" TOTAL PERMIT FEE DUE /�i ♦40 L'
VISA .t,--2. :,•
0 CASH .7— CHECK 0 =OM 0 '_._- -_
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Spo'lane
11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
Spokane Valley,WA 99206 509-688-0037-Fax
Plumbing Permit Application
PROJECT /6 Z Z 1 / it L 1Q N Fr, PERMIT t e"v Res : w/3 c rt r 4-11:-
ADDRESS: �- USE:
� p� Ic.4-►rte 1,41 tc _
OWNER: Ct eG rip 0 ) Aa I If C./ PHONE(Daytime Contact):
.y r,r. i3
`' L L L
MAILING ADDRESS: 1
21 7 s"2_
14
(street) (city/state) (ZIP)
CONTRACTOR: S A- LICENSE#: q Qv r 5 1_Y� W n ( n A
MAILING ADDRESS: PHONE#: -I l�
S E(9 92i 9.7s 2..
(street) (city/state) (ail •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNTTS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 2, X $6 - /
2 URINALS X $6 -
3 TUBS / X $6 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT _ 2 X $6 - 1 Z,.
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER i X $6 - (p ,
7 CLOTHES WASHER I X $6 - 6
•
8 GARBAGE DISPOSAL / X $6 G,
9 WATER SOFTENER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 =
11 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 X $6 -
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 X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM ' X $25 -
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 =
-
SUBTOTAL:
METHOD OF PAYMENT
.11117a5&041;�- PLUS PROCESSING FEE: $35.00
] CASH `CHECK 0 NM= 0 _- "
TOTAL PERMIT FEE DUE: O
rt�Le
>ATE: EXPIRES:
ANKCARD NUMBER:
UTHORIZED SIGNATURE:
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p/ 4767
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