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 ��
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