2004, 03-25 Permit App: BLD-04-03888 Residence Sliaan'#e\II'
1 ValeY
' 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
STREET ADDRESS: /o' / 3 c.' 9 i:_:4 Z. i4 N.: 2 A fie ," J L 14 /C S'eo 1c V►'� R
('
-37
ASSESSOR'S TAX PARCEL NUMBER(S): � ZLI/ . 2 6 Q 9 �
7
LEGAL DISCRIPTION: L0 T (p ('7 Lr)c iC Z 41 41 Ad8 c±i E 10
PERMIT DESCRIPTION: /k/I LA.) 0 e S', U /3 CA-r (4-ft GA. r. P,,,( ( 3 4- r e 6�
atRUILDING PST O CHANGE IN USE 1 GRADING I]MANUFACTURED HOME
D-RELOCATION aSIGN aTENANT EtatHER
1 OWNER / APPLICANT INFORMATION
1
OWNER: 6.7^ ,;':;.,11,7e -- w• r w Die. S'® APPLICANT: / vi Z
PHONE: ,- FAX: PHONE: FAX:
r
ADDRESS r s ' ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
°CONTRACTOR: IA VIA CL- ARCHITECT:
PHONE: FAX: c/a I ''77(I,„ PHONE: FAX:
ADDRESS: ADDRESS: �
CITY, Q/ s
.STATE,ZIP / NC�1CP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# 9 �L7 r, n Vv 6.9/P8 CONTACT: - e r•/ C'3L tie
PERMIT/BUILDING INFORMATION
COST OF PROJECT: /3/ w 30%SLOPES ON PROPERTY: - MAIN FLOOR SQ FT: / t?g 7 Stc
/ ,
BUILDING HEIGHT TO PEAK: /9,(o OCCUPANCY GROUP: R 2 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 56'ix (03 ' CONSTRUCTION TYPE: ��I\) UNFIN BASEMENT: / g/a s F
NUMBER OF STORIES: I STRUCTURES ON PROPERTY:j-v ge FINISHED BASEMENT:
NUMBER of BEDROOMS: 3 CRITICAL AREAS: GARAGE: OU 2- 5 P
FLANKING SETBACK: --- CURRENT PROPERTY SIZE: /Z(7`?8 S R COVERED DECK: N/A
/
FRONT SETBACK: 2 Z ' CURRENT PROPERTY USE: L/l Alk)1 DECK: /2 xC /`7
REAR SETBACK: G//• 0 / CURRENT SEPTIC USE: ! - /i
I
LEFT SETBACK: / V CURRENT WELL USE: NM
i
RIGHT SETBACK: /CP IMPERVIOUS SURFACE AREA: ---
MANUFACTURED HOME SIGN I
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
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
1 WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I
SPECIAL INSPECTIONS I
0 BOLTING °CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: a COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: a
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 0 NO PSSA: 0 YES 0 NO
IDATE: I STAFF: I
METHOD OF PAYMENT:
0 �■�i
a K ® ' WM
CASH CHECK Lmionim
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BEACCEPTED WITH MAJOR BANKCARD
S(�cJT1 c ! �uw� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
po ; ne Spokane Valley,WA 99206 509-688-0037-Fax
do,*Valley
Mechanical Permit Application
PROJECT /to yo 3 �j/ L (n e PERMIT / ,, ,QQ S c_4_, /3 cpk,e`
ADDRESS: 5 LI e ( (e`. Lk_ S(.c)lc (f i.( 9%3 7 USE:
� Ai?f C70 r'
OWNER:/-7_. c' ! / �hi' /t /�C T/e -7,,,,_-7,,,,_ PHONE(Daytime Contact): J>J Z
MAILING DRESS:
Pc (>o)( 5 2__ erry a (..., .e_—
(street) (city/state) t_t Ler1,7k.. (ZIP) 9 9so 77
CONTRACTOR: > LICENSE A: 9.,7v t__ ‘i:' zQ .7/108
MAILING ADDRESS: PHONE I:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK #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 S50 =
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 - iX $10 = /()
13 RANGE - / X $10 = i 0 r
14 DRYER - X $10 =
15 FUEL BURNING WATER HEATER - ! X $10 - /v r
16 MISC FUEL BURNING ADPL. - X $10 =
17 GAS PIPING(ea Outlet) - 2 X $1 - z r
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - _'` X $10 = jam,
20 AIR HANDLER(DOES NOT indude 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 - / X $10 = /U.
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: e7
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
",
Yom. } kms .' TOTAL PERMIT FEE DUE: /Z2,0)
0 CASH CHECK 0 0 t______=
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
rn4�x 11707 East Sprague Avenue,Suite 106 509-688-0036 Phone
Sgol �ane • Spokane Valley,WA 99206 509-688-0037-Fax
1ey
Plumbing Permit Application
PROJECT I Co`i O 3 a.S r�i 4-4 N127 PERMIT Al P c--, k' 'S (---)73 c,/''
ADDRESS: 5`n e(lei.( L r k. S io!e- VA-11,4/ 9537 USE: /7 7r 63,4 r.
OWNER: Geo 4rci i-k WA„IV a,,,,` _ PHONE(Daytime Contact): 9 2 f of 7,52
MAILING ADDRESS:
e._0. 36--/- oZ L t 6er7'1/4/
LLk
(street) (city/state) /, ,4 9 fp/ (ZIP) 6)0,j2_
CONTRACTOR .5 f e_ LICENSE#: 1 Ec--) /`7"1/ w 49 7>i°
Z�
r?
MAILING ADDRESS: PHONE 1:
72-/ 9702_
(street) (city/state) (Zn') '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS 2- X $6 - /2.-
2 URINALS X $6 -
3 TUBS Z X $6 = /2 ,
4 SHOWERS(PER TRAP) BATH,STALL ON-SITE BUILT / X $6 - ep .
5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 - 3 c)
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER / X $6 - 6 .
7 CLOTHES WASHER / X $6 - Co ,
8 GARBAGE DISPOSAL / X $6 - 4p-
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 - 1p
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 X $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
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: ck a'
v1ETHOD OF PAYMENTMEM
4f. ty i; PLUS PROCESSING FEE: $35.00
CHECK 0 MININ ❑ .-._
TOTAL PERMIT FEE DUE: /2 �..
)ATE: EXPIRES:
3ANKCARD NUMBER:
WTHORIZED SIGNATURE:
•
ID117Z '
Sr—
fit 0
I 0
0
I ti •F 0 a ADDRESS r.
I �� �' 1t g D ZONE
AD WIDTH 2 _
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���, 7 CO MENTS 7
V� � !!d�� RE IEWEDBY �r/1f�•l,
V
This ;ite plan is being submitted for the purpose f
j Jv ob ining a building permit and is a true and torr
r •resentation of the proposal. All known y
I Ines/dimensions,curb lines,structu and e s
have been identified. Also • are we
I , bodieCs e1 water, steeps critical are .
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