2004, 02-19 Permit App: BLD-04-03586 Residence sboryland,e\,,
400 AValley
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
40'
STREET ADDRESS: / ,3 Z �t c • 1 ( L4 //__ jj
ASSESSOR'S TAX PARCEL NUMBER(S): ' IS 2`�, , 9 (J 5� (( f
LEGAL DISCRIPTION: L. / Ck'C ' A d s f
I !
PERMIT DESCRIPTION: C ; i4 L-A.) / 3 .4 r FA " Ce r (01/4'
rr 'UILDING PERMIT C_CHANGE IN USE 0 GRADING 0 MANUFACTURED HOME
a RELOCATION 0 SIGN E TENANT 0-0 IIIER
OWNER / APPLICANT INFORMATION f
® OWNER: '"r jt, 7fb iter . �,.v94 'f✓
® APPLICANT: OS A
PHONE: ` i'AX: PHONE: FAX:
ADDRESS: J ` ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®CONTRACTOR: S P' Ink E'--_) ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# e U P L.,) 6,9 I"' CONTACT: I e f C,1 9 9' 7
PERMIT/BUILDING INFORMATION
COST OF PROJECT: / 2 t) 00 0 30%SLOPES ON PROPERTY: I"..' MAIN FLOOR SQ FT: J 6`jS
BUILDING HEIGHT TO PEAK: 2 0 OCCUPANCY GROUP: R t 2ND FLOOR SQ FT: ✓—
BUILDING DIMENSIONS: 4(0 14 CONSTRUCTION TYPE: V IV UNFIN BASEMENT: �/
NUMBER OF STORIES: STRUCTURES ON PROPERTY: N° FINISHED BASEMENT:
NUMBER of BEDROOMS: Z. CRITICAL AREAS: GARAGE: O z
FLANKING SETBACK: CURRENT PROPERTY SIZE: / /,7 7 0 S 1= COVERED DECK: I'J 0
FRONT SETBACK: 'I I CURRENT PROPERTY USE: U 4 C.. f DECK: J 7
REAR SETBACK: 5`( 3 CURRENT SEPTIC USE:
LEFT SETBACK: ( 2 CURRENT WELL USE:
RIGHT SETBACK: I IMPERVIOUS SURFACE AREA: ---
MANUFACTURED HOME SIGN
WIDTH: r 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 _ I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
0 BOLTING ®CONCRETE 0 REINFORCEMENT 0 WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® 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: 0 YES 0 NO PSSA: 0 YES ® NO
IDATE: I STAFF: '
METHOD OF PAYMENT:
T 0 .....•® CASH CHECK ® L imM
mim
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
0(371t 0111 �usrrsi 11707 East,Sprague Avenue,Suite 106 509-688-0036-Phone
pO ne Spokane Valley,WA 99206 509-688-0037-Fax
jValley
Mechanical Permit Application
PROJECT ‘ (Ce '3 *9 CI,N 1,•10e PERMIT .t 4, N' r e3. C 4. O vi-t. . (-4 K A•-Is C Ll
ADDRESS: 4?t.k.,./ '„.w3 4_ , <,,. ;u,, .. ' •
' ri USE: {s..Y r
)44,41 if
OWNER: PHONE(Daytime Contact): ---
t*c tr`�
MAILING ADDRE�` a , _ p�. 9 C "4/6
y 6 Cc
.:Jtg: ,r7,.. I,p/64_,
�£;. sej xdX.
(7 rt
(street) - (city/state) (ZIP)
CONTRACTOR: �` t t" �}�` Ij LICENSE#: E "—lex
MAILING ADDRESS: PHONE#:
(r
(street) (city/state) (ZIP)
DESCRIPTION OF WORK 8 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 - 1 X $10 =
J U
13 RANGE -
d X $10 - i ()
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - If X $10 - /0
16 MISC.FUEL BURNING APPL. - X $10 -
17 GAS PIPING(ea.Outlet) - 2 X $1 - '7--
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - 3 X $10 - 3 C:
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 - 1 X $10 = / v
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: 0 '
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
115.4 .=OM � I TOTAL PERMIT FEE DUE: i 22 0O'
0 CASH CHECK 0I 0 T_
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
CSc�r4 cx .'/ 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
pokane Spokane Valley,WA'99206,' 509-688-0037-Fax
I0Valley
Plumbing Permit Application
PROJECT l (Q 3 rr2 3 972' L a4 N G PERMIT Rif S i 0.e-Y,7 f rC
4
ADDRESS: 'S.ane.L ke`l LA ke , S p<3 tc Vri( te'„;:37uSE: 3 c ul r 1,411 rL, 641(! IAC (,t
OWNER: PHONE(Daytime Contact): '�P i ref
MAILING ADDR s,q�8 c �' � _ a
vei ire r„. 4 L.e9 ,7a:r„
(street) - ) (city/state) (ZIP)
CONTRACTOR: ,.T a .', c0 00 19 LICENSE#: q. ,g) t` s
MAILING ADDRESS: PHONE#:
(`�`aOq) '- 2/ 7a C-
CS (4 t.."Ae. )
(street) (city/state) (LU-')
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 2 X $6 = /
2 URINALS X $6 =
3 TUBS 7.- X $6 -
I L,
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT t X $6 - CC
5 SINKS LA VS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 14 X $6 - 2 L//
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER ( X $6 = (P
7 CLOTHES WASHER I X $6 - C
8 GARBAGE DISPOSAL / X $6 - uPi
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 • C<
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, t X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6
17 X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X
HOLDING TANK -
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL: 64 -;;
METHOD OF PAYMENT
I}?k t PLUS PROCESSING FEE $35.00
0 CASH (; CHECK 0 Man 0 •._.- .7-'1. --_=
TOTAL PERMIT FEE DUE: / 19, °
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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