2004, 10-05 Permit App: BLD-04-07857 Residence ILDING PERMIT APPLICATION WORKSHEET
ETII'
City o
`� 1 e Valley Community Development Department
� Building Division
-" 11707 E. Sprague Avenue, Suite 106
.000VailePi.���M vy
n� Spokane Valley, WA 99206
-, 5one: (509) 688-0036;Fax: (509) 688-0037
q lbj II\ fSITE INFORMATION
,.-% 9 MI' •
Street Address: / 6 / ) ' Ce
Assessor's Tax Parcel Number(s): 7
LL) T 77 4O c it- ,2/ S/& C ie/A 4/,- '-'----
Legal Description:
PERMIT DESCRIPTION: le E CCS E I VI U
¢wilding Permit Chan•e ine0 . ���
❑ �❑ ding ❑ Manufactured Home
❑ Relocation ❑ Ter Ir; Improvement DI i Safety 0 Other
OWN _ - APPLICANT INFORMATION
❑ Owner:6,b , ' , ‘A.) Qr IlYi ,
Applicant:
Phone: 791-Ot/ 41 Fax: 9 /— a17 7 4 Phone: Fax:
Address: Address:
City State Zip Code r City State Zip Code
❑ Contractor: ('o RtY (.--
Phone: ql I _0m c 1 0 Architect:
� �I Fax: 2 - X77
Phone: . Fax:
Address: e3 0 v 5-2/ e iso. c.A, ,a.- "Pt l Address:
City State Zip Code City State Zip Code
)69WA State Contractor License#04171?--k'1-! f l &ontact: ( R4G� 99'�D"e/2
91
PERMIT/BUILDING INFORMATION J
HEIGHT TO PEAK f DIMENSIONS:6 0 ),„ ,i / #OF STORIES:
MAIN FLOOR TO,,SQQFTG: 2"'r FLOOR SQ. FTG UNFIN BA AMEN SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: 8 DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: S RCE:
o 0 a ,�
#OF BEDROOMS: G/ TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: > PE30%SLOPES ON PROPERTY: SEWER 0-`,DN-SITE SEPTIC
/
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eget A' ,
MECHANICAL PERMIT APPLICATION
Só1 ' h1hh1th
aneCity of Spokane Valley Community Development Department
BuildingDivision
le 11707 E. Sprague Avenue, Suite1106
4,,,Val
Spokane Valley, WAA99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: L��j Permit Use: ,_Br ��
Owner: �6 ' (N1- 172 -77Y( ' hon Daytime Contact): I��
Mailing Address: (V/ SIS_ 4/4264$ ---72)---.9*"-" "°' City State Zip Code
Contractor: f " Ir/ L T License#: Phone#:
Mailing Address: City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 _ / X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min.AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 -=
10 BOILER/REFRIGERATION 1,001-1,750M BTU _X $57.00 ,=
11 BOILERIREFRIGERATIO$:m,----- may More than 1,750M BTU X ; $95.00 =
12 GAS LOG,GAS INSQT)GAS_FIREP ACE^ "� / X $10.00 , =
13 RANGE / X $10.00 =
x $10.00 , _
14 DRYER - /
15 FUEL BURNING WATER HEATER 6-0 6 P-( , ( X , $10.00 _=
18 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) / X $1.00 =
18 DUCT SYSTEMS / X $10.00 , _
19 VENTILATING FANS X $10.00 =
20 AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 = ,
21 AIR HANDLER(DOES NOT Include ducting) Greater than 10,000 CFM X $19.00 =
22 EVAPORATIVE COOLERS / X $10.00
X $50.00 =
23 TYPE I HOOD
24 TYPE II HOOD X $10.00 =
9
25 HEAT PUMP/AIR CONDITIONER 0-3 TON / X $12.00 =
26 AIR CONDITIONER3-15 TON X $20.00 =
27 AIR CONDITIONER
15-30 TON X $25.00 =
28 AIR CONDITIONER
30-50 TON X $35.00 =
29 AIR CONDITIONER
More than 50 TON X $80.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK IVISA ❑MC
DATE: PROCESSING FEE $35.00
EXPIRES:
CARD#: TOTAL PERMIT FEE DUE:
' r !"""'``
AUTHORIZED SIGNATURE: ,
PLUMBING PERMIT APPLICATION
P° City of Spokane Valley Community Development Department
rr �jtj;� BuildingDivision
Lilley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
17'(y// 4; �.
FOR INSPECTIONS, CALL(509)688-0054
Project Address:/� Permit Use:
Owner: C��' `, ''), ILO)4 'T -,ItsrY (, Phone (Daytime Contact): 7�0y2cl
Mailing Address: 1�CJ.)C Ste. L 145, C k , t-J 11 e
,p �� r t rc ', y\ 1,- 1 SIC State Zip Code
Contractor: V R f C, CO License#: Phone#:
Mailing Address:
City State Zip Code
1 #OF TOTAL
DESCRIPTION OF WORK UNITS X COST AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $8.00 =
2 URINALS X $6.00 =
3 TUBS / X $6.00 ,=
4 SHOWERS(PER TRAP) BATH,STALL ON-SITE BUILT 2' X $6.00 =
5 SINKS - LAVSIBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, / X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD, (�
PREP/CULINARY/MEAT
6 DISHWASHER f X $6.00 , =
7 CLOTHES WASHER / X $6.00 =
8 GARBAGE DISPOSAL I X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =,
13 FOUNTAINS,DRINKING X $8-00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
16 WATER USING DEVICE ICEA R COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK ,, ISA 0 MASTERCARD PROCESSING FEE $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE T' -
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