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2004, 01-15 Permit App: BLD-04-03410 Residence CV OF ► , .000Valley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 Phone:(509)685-0036 Fax:(509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: 1 69 3 q9/4 LA) ASSESSOR'S TAX PARCEL��NUMBER(S): I LEGAL DISCRIPTION: ..(.J / 41 134K s 5)40, /4 Y" 466 PERMIT DESCRIPTION: et S) de- )3UILDING.PERMI'T $D-CHANGE]1v USE a GRADING a MANUFACTURED HOME CI-RELOCATION ®SIGN ®-TENANT [OTHER 1 OWNER / APPLICANT INFORMATION ® OWNER: ® APPLICANT: PHONE: FAX: PHONE: FAX: A DRESS: ADDRESS: CITY,STATE,ZIP CITY,STATE,ZIP CONTRACTOR: ( -1 1 1F Se )rZ e.6)-a15?' ® ARCHITECT: PHONE: 149-'7713 FAX: yl/-I '7/ PHONE: FAX: ADDRESS: /(0�j J„D g.. Shed'(JCS i7weity ADDRESS: //��// CITY,.STATE,ZIP g�j'6r7 CITY,STATE,ZIP Vl ' WA ST CONTRACTOR LICENSE# -hrieSGIeW/KF CONTACT: e 11 c' I PERMIT/BUILDING INFORMATION COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: iy BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT: 6/ BUILDING DIMENSIONS:S.5.70 St/ CONSTRUCTION TYPE: UNFIN BASEMENT: 14/79 r NUMBER OF STORIES: . STRUCTURES ON PROPERTY:. ) FINISHED BASEMENT: '6)-- NUMBER of BEDROOMS: 3 _ _ CRITICA!._AorAS• r"„ r^r:• 7Z0 FLANKING SETBACK: CURRENT PROPERTY SIZE: 7 7Q COVERED DECK: FRONT SETBACK: ZS CURRENT PROPERTY USE: -Q ` DECK: REAR SETBACK: 3Z CURRENT SEPTIC USE: $' LEFT SETBACK: 9 CURRENT WELL USE: $19”RIGHT SETBACK: 5.4 IMPERVIOUS SURFACE AREA: I 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 PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM: PAINT BOOTH: TENT: PROPOSED USE: FIREWORKS DISPLAY: BLASTING: DATE/TIME: I WA STATE NON-RESIDENTIAL ENERGY CODE I PLANS EXAMINER: PHONE: FAX: ADDRESS:. CITY,STATE,ZIP INSPECTOR: PHONE: FAX: ADDRESS: CITY,STATE,ZIP I SPECIAL INSPECTIONS I ® BOLTING ®CONCRETE a REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY IS PUBLIC SEWER.AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY IS PUBLIC WATER AVAILABLE: ® 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: ® YES ® NO PSSA: ® YES 0 NO II DATE: STAFF: McT /7 OF P:4 YML•NT• i Nf1 CI L ® r Li ...... WM CASH CHECK BANKCARD#; EXPIRES: VIN# AUTHORIZED SIGNATURE' *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD ,s,,,, ,,.- _. „-.-,e..w,.»„�i.».• �..�......�..,—. ....,.�,,.,-w....�..,.�,,,,. ,,.. mrcr. ,wR+oa .�.,.m�,. �,. �,;..,��wwava.«w.. ...-. , _ Scrrl1�. 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone cpokane waw, Spokane Valley,WA 99206 509-688-0037-Fax ,••0*Valley For Inspections, call 509-688-0054 Mechanical Permit Application PROJECT PERMIT ADDRESS: USE: OWNER: PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) CONTRACTOR: lj I ue 1 774)G LICENSE#: MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) DESCRIPTION OF WORK #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<400,000 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 - I X $10 = 13 RANGE - X $10 = 14 DRYER - X $10 = 15 FUEL BURNING WATER HEATER - ) X $10 = 16 MISC.FUEL BURNING APPL. - X $10 = 17 GAS PIPING(ea.Outlet) - 3 X $1 = 18 DUCT SYSTEMS - X $10 = 19 VENTILATING FANS - y X $10 = 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 = 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 CONDMONER +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: METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00 ` TOTAL PERMIT FEE DUE: VISA" r � ,' 0 CASH 0 CHECK 0 0 I__._...':.f::_._ DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: Scrr4< jT/�1" 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone pokane Spokane Valley,WA 99206 509-688-0037-Fax ,r00Valley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: / (o 3 b Li % USE: OWNER: lY PHONE(Daytime Contact): • MAILING ADDRESS: (street) (city/state) (ZIP) CONTRACTOR: T fmmy P4 ){,)106 LICENSE#: MAILING ADDRESS: , PHONE#: (street) (city/state) (ZIP) ' PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS 7 X $6 - 2 URINALS X $6 - 3 TUBS 'zj X $6 - 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT / X $6 - 5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- / X $6 - RAY,FOOD,PREP/CULINARY/MEAT 1(��f 6 DISHWASHER / X $6 - 7 CLOTHES WASHER J X $6 - 8 GARBAGE DISPOSAL r X $6 - 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 r 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 R.P.B.P.D.FOR:VATS,TANKS,BOILERS X - 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 • assl PLUS PROCESSING FEE: $35.00 0 CASH 0 CHECK ❑ UM= ❑ L__:...,-_--:_` TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: PLANNING DEPT. APPROVED BY:- e �� / 1 DATE:_!_/L riot 91 qo • 1 1)1 1122 • A ' 1 "rA10, Lot lit tLb' lu f (030z-i ( 1q141 Lo - y BOK S 5)-Iddieq 144 y id