2003, 10-22 Permit App: BLD-03-02850 Residence sconakantiSire\mork . ,
4000Vailey
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
IREQUIRED SITE INFORMATION T .,
STREET ADDRESS: l l0 31 1( let n'!
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: 1.-.OTS IS 4...,K < 5 1k1iail Ake 4/44(
PER DESCRIPTION: 1 OetZ
RUI DING PERMIT 0 CHANGE IN USE CI GRADING 0 MANUFACTURED HOME
0RELOCATION 0-SIGN 0-TENANT 0.O1ttER
OWNER / APPLICANT INFORMATION
® OWNER: ® APPLICANT:
PHONE: . FAX: PHONE: FAX:
KESS: ADDRESS:
leb
//f� CITY,STATE,ZIP .. CITY,STATE,ZIP
CONTRACTOR:QL Sti (Tz. Cii 4t ARCHITECT:
PHONE: ! 3 773'j FAX:_r_1±74Z40,02 PHONE: FAX:
ADDRESS: 11015-Z-0 t. SfCr4 49/37 ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# Ck4 S $C 1OgRG ' CONTACT:
PERMIT/BUILDING INFORMATION ,
I
COST OF PROJECT: 30%SLOPES ON PROPERTY: 6' MAIN FLOOR SQ FT: /O2
BUILDING HEIGHT TO PEAK: 251 OCCUPANCY GROUP: 2ND FLOOR SQ FT: Ve6
BUILDING DIMENSIONS:c0C6?� CONSTRUCTION TYPE: UNFIN BASEMENT: &VIZ
'NUMBER OF STORIES: Z, STRUCTURES ON PROPERTY: .� FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: /
FLANKING SETBACK: CURRENT PROPERTY SIZE:8.75b. COVERED DECK: 49-
�/
FRONT SETBACK: Z J CURRENT PROPERTY USE: /4O DECK: -a-
REAR SETBACK: a? CURRENT SEPTIC USE: 'Cr
LEFT SETBACK: 1 Z CURRENT WELL USE:_ er-
RIGHT SETBACK: 1i/ IMPERVIOUS SURFACE AREA:
MANUFACTURED HOME SIGN JI
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
CI BOLTING ®CONCRETE ® REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY -
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES 0 NO • PSSA: 0 YES 0 NO
DATE: STAFF:
METHOD OFPAYMENT.•
0 0 0 r - 0 ...1... '
CASH CHECK Mui
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
((��CTY< n 11707 East,Spiagut Avenue,Suite 106 509-688-0036-Phone
1J .� .11�e Spokane Valley,WA 99206 509-688-0037-Fax
'Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: 3/ CAL d.. /$f- LICENSE#:
MAILING ADDRESS:,` f�F 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 - / X $10 -
13 RANGE - X $10 -
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - I X $10 -
16 MISC.FUEL BURNING ADPL. X $10 -
17 GAS PIPING(ea.Outlet) - 3 X $1 -
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 3 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 IHOOD - X $50 -
24 TYPE II HOOD - 3 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 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:
METHOD OF PAYMENT PLUS PROCESSING FEE $35.00
{;MOM TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK ❑ 0 L. :
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
Saro OF 11707 East Sprague Avenue;Suite 106 509-688-0036-Phone
p0�.ne Spokane Valley,WA 99206 509-688-0037-Fax
4000 Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMTT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: 'will/,his PLu m 6,�G LICENSE#:
MAILING ADDRESS: 1" PHONE#:
(street) (city/state) (LIP) '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 -
2 URINALS X $6
3 TUBS Z
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
6 DISHWASHER / X $6 -
7 CLOTHES WASHER I X $6 -
8 GARBAGE DISPOSAL f 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 / 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, 3 X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
$6 -
RP.B.P.D.FOR:VATS,TANKS,BOILERS X
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 =
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL:
vIETHOD OF PAYMENT
. 'Z r=!` PLUS PROCESSING FEE: $35.00
] CASH ❑ CHECK ❑ =Min ❑ 2:-2-..;
TOTAL PERMIT FEE DUE:
>ATE: EXPIRES:
;ANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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