2003, 10-23 Permit App: BLD-03-02876 Residence Sinan'e\rilk
jValleY 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 1
STREET ADDRESS: /‘. 3Q5 e 7 H Spa 6. Vvi- I Icy 144 5-9-03 7
ASSESSOR'S TAX PARCEL NUMBER(S): '/1�` 2 yS 9/S
LEGAL DISCRIPTION: L 07- 3 &L v G lc 1 4( t Aaa.R'�'t t / she / ,,
Ie t 'A€
PERMIT DESCRIPTION: 5 t ,N 5 (e 1C4,„1 " it.)Q) ,„ S , t.,.)/1 c i r Gay'`,
OM:WING PERMIT O CHANGE IN USE a GRADING C MANUFACTURED HOME
DRELOCATION 0-SIGN QTENANT C-Of'IER
OWNER / APPLICANT INFORMATION i
OWNER: kili.--‘4* ...- PPLICANT: 'Ar1 'i &_
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
CONTRACTOR:
George Willie, 0
ARCHITECT:
PHONE: Ti,L J.G PHONE: FAX:
ADDRESS: J e-liberty-C,*,,* -cTyl -90,- ® ADDRESS: CITY,STATE,ZIP
�-.' 61Tf/(;-90, ZIP
WA ST CONTRACTOR LICENSE# ea( I IA)n co P 8 CONTACT: 1 e P r (...,A€ g2/ 7,0-2
PERMIT/BUILDING INFORMATION 1
COST OF PROJECT: / 7 4 S 30%SLOPES ON PROPERTY: Ai° MAIN FLOOR SQ FT: / 1 CD S
BUILDING HEIGHT TO PEAK:20`,(0/ OCCUPANCY GROUP: R - 3 2ND FLOOR SQ FT: ,--
BUILDING DIMENSIONS:��A57. ' CONSTRUCTION TYPE: J 6L) UNFIN BASEMENT: )7/6 5"
NUMBER OF STORIES: / STRUCTURES ON PROPERTY: / FINISHED BASEMENT: ND
NUMBER of BEDROOMS: 3 CRITICAL AREAS: r GARAGE: 1 41
FLANKING SETBACK: CURRENT PROPERTY SIZE: 12y 2 17 SF- COVERED DECK: PO
t
FRONT SETBACK: 2U ' CURRENT PROPERTY USE: 04-C.A-v.0- 2 DECK: I >(
REAR SETBACK: 3 v ' CURRENT SEPTIC USE: --
LEFT
LEFT SETBACK: /D 1 CURRENT WELL USE:
RIGHT SETBACK: I C.) '' IMPERVIOUS SURFACE AREA:
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:
1
WA STATE NON-RESIDENTIAL ENERGY CODE 1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
t tt SPECIAL INSPECTIONS I
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: 0 YES ® NO IF YES: 0 COUNTY 0 CITY
IS PUBLIC WATER AVAILABLE: 0 YES ® 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: 0 YES ® NO PSSA: 0 YES 0 NO
'I iI DATE: 'I STAFF:
METHOD OF PAYMENT:
0 lig ® l 0 Nom=
r r VISA
CASH CHECK
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
art 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Q Spokane Valley,WA 99206 509-688-0037-Fax
_Mille
Plumbing Permit Application
PROJECT /, 3O5 e 5°'42 s eo tilf/f r./ PERMIT 1V c-4) S/A /e .sal„Y- , Aloe•S
ADDRESS: LA., 64 990..,4""7, USE: / a c 6 4 (A„
OWNER: c PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR ` �GQ�e .� r ., 711
LICENSE#: q e.�i”IA LA.) & 9, g8
�. ntre0.
,
MAILING ADDRESS: JrZ PHONE isDOX Z/
Gibes G / Wa, 99019
(street) (city/state) (LU') .
PLUMBING FIXTURES
DESCRIPTION DETAILS t OF UNTTS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 i'
2 URINALS X $6 -
3 TUBS , X $6 = 6,
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 2. X $6 - /2. ,
5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, -
LAUNDRY,UTILTrY,JANITOR,PHOTO,X- "� X $6 - 3 G .
RAY,FOOD,PREP/CULINARY/MEAT Co6 DISHWASHER / X $6 - r
7 CLOTHES WASHER
X $6 - t
8 GARBAGE DISPOSAL / X $6 es"
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 - cp ,
12 FOUNTAINS,DRINKINGX $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, 3 X $6 -
0
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X $6
RP.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM I X $25 2-c,
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: i I
v1ETHOD OF PAYMENT
IMMINIE. • ,e� PLUS PROCESSING FEE: $35.00
CASH 0 CHECK 0 IMMO 0 '--- .- dO
TOTAL PERMIT FEE DUE: i 0 ..
)ATE: EXPIRES:
3ANKCARD NUMBER
AUTHORIZED SIGNATURE:
Sant 40 \rrk, 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
„jV.11ey
Mechanical Permit Application
•
PROJECT /LP 305 6 / ty PERMIT s„vriaJe. Ails-r1 e°"a.4..l arse'
ADDRESS: 5 p 6 04_t ley IA), clq„6 3 7 USE: W f 3(c A r ,=.,{" ,
OWNER: S PHONE(Daytime Contact): C, 13/u
MAILING ADDRESS:
(street) ,11 (cityy/state) (ZIP)
CONTRACTOR: �e�� White1� �Lte1 11W, LICENSE A: e " /
MAILING ADDRESS: (Brosy�?2 PHONE It:
Li6ert1. Lake, Wa. 99019 g < - .
5-2
(street) (dry/state) (ZIP)
DESCRIPTION OF WORK It OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 / X $15 = ®'j
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 - ! X $10 - ,1 Ci
•
13 RANGE - / X $10 - /42
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - # X $10 - f .
16 MISC FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea Outlet) - X _ $1 - 3
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 3 X $10 - (]
e
20 AIR HANDLER(DOES NOT include ducting).. =OR c 10,000CFM X - $12 =
21 AIR HANDLER(DOES NOT indude ducting) >10,000 CFM X $19 -
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50 =
24 TYPE II HOOD - / X $10- _ /Y;)
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: g Qj E344)
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
'` TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 liZia= 0 s .
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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APPROVED B
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