2003, 10-23 Permit App: BLD-03-02873 Residence si
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""""'_J 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
1 REQUIRED SITE INFORMATION
STREET ADDRESS: 16 / E Cf L,14-we / -4-4€ h- it 1/1/0- �f o3 7
ASSESSOR'S TAX PARCEL NUMBER(S): T' Z''d I S5 y
LEGAL DISCRIPTION: L 07" 3-t �aLoc.k '� SE..I Ie.-t 1-14-kg? Aj I. 144:14
(+E 0
PERMIT DESCRIPTION: S 9 e Fes-t ( J I > R s -
"'BUILDING PERMIT CI CHANGE IN USE C GRADING a MANUFACTURED_HOME
DRELOCATION 13 SIGN }TENANT ®-OTHER
OWNER / APPLICANT INFORMATION
® OWNER: 5 ® APPLICANT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACT eOp1ge. White, Dia ® ARCHITECT:
PHONE: LL�� 9 5"2 FAX: PHONE: FAX:
ADDRESS: Linen- L„ai ' 74,,a 99019YADDRESS:
,STATE,ZIP CITY,STATE,ZIP
C1T(
WA ST CONTRACTOR LICENSE# G Cra ,l°5 VI 1.4,) So 9/ Pe CONTACT: re ue 92( 9,32-
PERMIT/BUILDING
T7,52PERMIT/BUILDING INFORMATION
COST OF PROJECT: I r7, 54 g, ra9 30%SLOPES ON PROPERTY: N 0 MAIN FLOOR SQ FT: /
BUILDING HEIGHT TO PEAK: 30 r OCCUPANCY GROUP: R '3 2ND FLOOR SQ FT: --
BUILDING
—BUILDING DIMENSIONS: (0 )) fa # CONSTRUCTION TYPE: 5-1A) UNFIN BASEMENT: /gig
NUMBER OF STORIES: STRUCTURES ON PROPERTY: I FINISHED BASEMENT: Nat S
O
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE: 3 GA it" ,
FLANKING SETBACK: " CURRENT PROPERTY SIZE: 11,22 c F COVERED DECK: P
FRONT SETBACK: CURRENT PROPERTY USE: DECK: ! 2 )C S'
REAR SETBACK: ' ' CURRENT SEPTIC USE:
LEFT SETBACK: /0 CURRENT WELL USE:
RIGHT SETBACK: /0 IMPERVIOUS SURFACE AREA:
EMANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY f
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
t WA STATE NON-RESIDENTIAL ENERGY CODE
1
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS I
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY 1
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: ® YES ® NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES a NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES a NO PSSA: 0 YES ® NO
IDATE: I STAFF:
METHOD OF PAYMENT:
0 moms
® ® KIs s VISA
CASH CHECK min
BANKCARD#; EXPIRES; VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
rslart ,//"" ,, ,„�, 11707 East Sprague Avenue,Suite. 106 509-688-0036 Phone
� .ne Spokane Valley,WA 99206 509-688-0037-Fax
,,sValley
Plumbing Permit Application
PROJECT 1(P . ,f7 E rlr‘ l..t t; 4. tiI1'(( PERMIT g yy,5 Ce "'+9'"1.-4^a iVe4„..k) gej
ADDRESS: L.vi 4,4037 USE: w ( 3 C kr ce 4-r,
OWNER PHONE(Daytime Contact):ry 'a.L(s-e
MAILING ADDRESS:
(s r,qe 5L White, (state) (ZIP)
CONTRACTOR Box 52 LICENSE#: 4 c V tr-1 1,,,..., st,5 e.es
MAILING AD j /L -£yl Was 99019 PHONE it: 7 i1 C!7 6.
(street) (dry/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6 ) t..-
2 URINALS X $6 -
3 TUBS j X $6 - Co
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT L. X $6 - /L.
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN, g
LAUNDRY,UTILITY,JANITOR,PHOTO,X- t.p X $6 - 3 to .
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 - 6 •
7 CLOTHES WASHER t X $6 - Ia
8 GARBAGE DISPOSAL
X $6 - [a .
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 COI rtt:MAKER,HOSE BIB,
STEAMER,PROOFER,CARBONATOR, X $6 - r 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 t X $25 - 2. '"--
18
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: /33 P4'
dETHOD OF PAYMENT
'. �'iza PLUS PROCESSING FEE: $35.00
] CASH 0 CHECK 0 EXIMINI 0 __ _ I.-
TOTAL PERMIT FEE DUE: t 69 ,co
)ATE: EXPIRES:
tANKCARD NUMBER:
LUTHORIZED SIGNATURE:
San< \ 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
potrle Spokane Valley,WA 99206 509-688-0037-Fax
..0,0 Valley
Mechanical Permit Application
' PROJECT Spo v*( k f PERMIT S t iiej be r 4-s eve , ",
ADDRESS: 1 (0 s t / g 9 W 4 997037 USE: / 3 4 Al r.,OAF r'
OWNER: S Ili-L-1,4-e.- PHONE(Daytime Contact):
SL I. 9 .�Z-
MAILING ADDRESS: Te(1"-,/ 151,,‘,...t.
genige White, Inc.
(street) ? (city/state) (ZIP)
CONTRACTOR LICENSE#:
Li6e C a, -s>a. 99019 era' 4
MAILING ADDRESS: '' PHONE#:
q2-t - 77,a
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE =OR<100,000 1 X S15 I£,
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 - /0
13 RANGE - 1 X $10 - t
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER 1 X $10 - /L),
16 MISC FUEL BURNING APPL. - X $10 =
17 GAS PIPING(ea.Outlet) - l X $1 - 3
18 DUCT SYSTEMS - X $10
19 VENTILATING FANS - I X $10 - l 0. •
20 AIR HANDLER(DOES NOT indude ducting) =OR<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 510 = J (. ,
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 560 =
30 LPG STORAGE TANK - X $10 -
31 WOOD OR PELLET STOVE/INSERT - X $10 -
32 WOOD STOVE-FREE STANDING - X $25 =
SUBTOTAL: ie.Jo
METHOD OF PAYMENT PLUS PROCESSING FEE $35.00
ick ,
V�� i`� j TOTAL PERMIT FEE DUE 1 33A,QA
0 CASH 0 CHECK 0 01.______.:-2.-` ..i
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORI7F.T)SIGNATURE:
`220
APPROVED
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