2004, 12-17 Permit App: 04009445 Residence Pi-oject Number: 04009445 Inv: / Application Date: 12/17/2004 Page 1 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Project Information:
Permit Use: NEW RESIDENCE W/ATTACHED GARAGE- Contact: SCHMITZ,CLIFFORD M
NATURAL GAS Address: 16520 E SECRETARIAT LN
C- S-Z: VERADALE,WA 99037-
Setbacks: Front 25 Left: 10 Right: 10 Rear: 42 Phone: (509)999-7733
Group Name:
Project Name:
Site Information:
Plat Key: Name: PINE ROCK RIDGE PUD District: East
Parcel Number: 45244.3104 Block: 3 Lot: 4
SiteAddress: 16420 E 9TH LN Owner: Name: SCHMITZ,CLIFFORD M
Address: 16520 E SECRETARIAT LN
Location::CSV VERADALE,WA 99037-
Zoning: UR-3.5 Urban Residential 3.5
Water District: Hold: El
Area: 8,550 Sq Ft Width: 75 Depth: 114 Right Of Way(ft): 32
Nbr of Bldgs: 1 Nbr of Dwellings: 1
Review
Site Plan Review Released B .
Plan Review Released By: JALk.\ -
Approach/Drainage Released By:
Sewer Review
Released By: -
Operator: K_C Printed By: K_C Print Date: 12/17/2004
PToject Number: 04009445 Inv: I Application Date: 12/17/2004 Page 2 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Building Permit
Contractor: CLIFF SCHMITZ Firm: CLIFF SCHMITZ CONSTRUCTIO
Address: 16520 E SECRETARIAT Phone: (509)922-4297
VERADALE WA 99037
This Application: Total Project:
Description Grp Type Notes So Ft Valuation Su Ft Valuation
2ND FLOOR R-3 VB 611 $45,629.48 611 $45,629.48
BASEMENT U R-3 VB 1,479 $22,185.00 1,479 $22,185.00
CARPORT U-1 VB 110 $1,650.00 110 $1,650.00
GARAGE U-1 VB 720 $13,680.00 720 $13,680.00
RESIDENCE R-3 VB 1,479 $110,451.72 1,479 $110,451.72
Totals: 4,399 $193,596.20 4,399 $193,596.20
Item Description Units Unit Desc Fee Amount
RESIDENTIAL PERMIT FEE 1 SELECT $1,520.15
STATE SURCHARGE 1 SELECT $4.50
RESIDENTIAL PLAN REVIEW 1 SELECT $608.06
Permit Total Fees: $2,132.71
Mechanical Permit
Contractor: STURM HEATING Finn: STURM HEATING
Address: 1112 N NELSON Phone: (509)325-4505
SPOKANE,WA 99202
Item Description Units Unit Desc Fee Amount
GAS WATER HEATER 1 NUMBER OF $10.00
GAS APPLIANCE<=100,000BTU 1 NUMBER OF $12.00
GAS PIPING 3 #OF UNITS $3.00
VENTILATING FANS 4 NUMBER OF $40.00
CLOTHES DRYER 1 NUMBER OF $10.00
GAS LOG OR GAS INSERT I NUMBER OF $10.00
HOOD-TYPE II 1 NUMBER OF $10.00
Permit Total Fees: $95.00
Operator: K_C Printed By: K_C Print Date: 12/17/2004
'roject Number: 04009445 Inv: 1 Application Date: 12/17/2004 Page 3 of 3
THIS IS NOT A PERMIT
Penalties will be assessed for commencing work without a permit
Plumbing Permit
Contractor: JIMMY'S PLUMBING Firm: JIMMY'S PLUMBING
Address: 1702 S MAMER Phone: (509)928-8991
SPOKANE,WA 99216
Item Description Units Unit Desc Fee Amount
TOILETS/BIDETS 3 NUMBER OF $18.00
SINKS 5 NUMBER OF $30.00
SHOWERS 1 NUMBER OF $6.00
TUBS 2 NUMBER OF $12.00
DISH WASHERS 1 NUMBER OF $6.00
GARBAGE DISPOSAL 1 NUMBER OF $6.00
CLOTHES WASHER 1 NUMBER OF $6.00
FLOOR DRAINS 1 NUMBER OF $6.00
WATER USING DEVICES 3 NUMBER OF $18.00
Permit Total Fees: $108.00
Permit Type Fee Amount Invoice Amount Amount Paid Amount Owing
Building Permit $2,132.71 $2,132.71 $0.00 $2,132.71
Mechanical Permit $95.00 $95.00 $0.00 $95.00
Plumbing Permit $108.00 $108.00 $0.00 $108.00
$2,335.71 $2,335.71 $0.00 $2,335.71
Disclaimer:
Submittal of this application certifies the owner(or person(s)authorized by the owner)has both examined and finds the information
contained within to be true and correct,and agrees that all provisions of laws and/or regulations governing this type of work will be
complied with. Subsequent issuance of a permit shall not be construed to be a permit for,or an approval of,any violation of any of the
provisions of the code or of any other state or local laws or ordinances.
Signature:
Operator: K_C Printed By: K_C Print Date: 12/17/2004
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BUILDING PERMIT APPLICATION WORKSHEET
an'ors ” _ . City cF Spok. Valley Community Development Department
pokSI1�t E E r' E IIW E Building Division
11707 E. Sprague Avenue, Suite 106
Valle400 ' 17,-:
1 4 2004 Spokane Valley, WA 99206
3�
� Mone: (509) 688-0036; Fax: (509) 688-0037
o Lid [1LThIA
REQUIRED SITE INFORMATION
Street Address: 16 420 6,, q
Assessor's Tax Parcel Number(s):
Description: 40-1-- ,4 61 K 3 S / i‹.' ke % 7i
)
PERMIT DESCRIPTION: 2R-S I be,?Pl
Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
❑ Owner: ❑ Applicant:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
Contractor: CL t PF SG(-(-in AT-e_.COekSr Architect:
Phone:Q7q-7733 Fax: "3 X44,/ )) Phone: Fax:
Address: 16,szo E . 5e c.ge,f Ac`T Address:
ueR-4o 4-zL I- P v3'9
City State Zip Code City State Zip Code
WA State Contractor License #: et I/C65CINAF Contact: C L /cam
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
lif Z� 55)6
.
MAIN FLOOR TO,SQ1TG: 2ND FLOgRS FTG: UNFIN 71$ MENT SQ. FTG:
FINISHED BAS/lEM'NT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
7Z0 i/o
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
6
#OF BEDROOMS: TOTAL H'BITABLE SP CE: IMPERVIOUS SURFACE AREA:
3 %';✓" 39 -9-
COST OF PROJECT: 30% SLOPES ON PROP RTY: SEWER OR ON-SITE
'165r SYSTEM?
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
RELOCATION
Previous Address:
Proposed Use:
FIRE SAFETY
Fire Sprinkler: # of Heads: Fire Alarm: Paint Booth:
Tent: Fireworks Display: Blasting: Date/Time:
Valuation: Above/Underground Storage Tank Size:
WASHINGTON STATE NON-RESIDENTIAL ENERGY CODE
Plans Examiner: Phone: Fax:
Address:
City State Zip
Inspector: Phone: Fax:
Address:
City State Zip
SPECIAL INSPECTIONS
❑ BOLTING ❑ CONCRETE ❑ REINFORCEMENT ❑ WELDING
Firm Name: Phone: Fax:
Inspector(s):
DISCLAIMER
The permitee verifies, acknowledges and agrees by their signature that: 1) If this permit is for construction of or on a
dwelling, the dwelling is/will be served by potable water. 2) Ownership of this City of Spokane Valley Permit inure to the
property owner. 3) The signatory is the property owner or has permission to represent the property owner in this
transaction. 4) All construction is to be done in full compliance with the City of Spokane Valley Development Code.
Referenced codes are available for review at the City of Spokane Valley Permit Center. 5) This City of Spokane Valley
Permit is not a permit or approval for any violation of federal, state or local laws, codes or ordinances.
Ownership of resulting development rights granted by any issued permit inure to the property owner.
Print Name Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash ❑ Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
Aiimi1k Building Division
hi ii
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
.o/Valley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: 164/2.0 C. 9 Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
/ /� b City State Zip Code
Contractor: 1 Th inq S f�Di&)C License#:' Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK *OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 =
2 URINALSX $6.00 =
3 TUBS 2. X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ONSITE BUILT ) X $6.00 =
LAYS/BASINS,BAR,FLOOR,KITCHEN,
5 SINKS LAUNDRY,UTILITY,JANITOR,PHOTO, X $6.00 =
X-RAY,FOOD,PREP/CULINARY MEAT
6 DISHWASHER I X $6.00 =
7 CLOTHES WASHER I X $6.00 = ,
8 GARBAGE DISPOSAL 1 X $6.00 =
9 WATER SOFTENERX $6.00 = ,
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE I X $6.00 =
ROOF DRAINS/OVERFLOW
12 DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
WATER PIPING/DRAIN-IN WASTE, NSTALLATION,ALTERATION,REPAIR,
14 VENT,PLUMBING,REVERSAL REVERSALS X $6.00 =
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER 3 X $6.00 =
PROOFER,CARBONATOR,SWAMP COOLER
VACUUM BREAKER,CHECK VALVE,
17 CROSS CONNECTION DEVICE AND R.P.B.P.D.FOR: VATS,TANKS,BOILERS X $6.00 =
GREASE TRAP,SAND TRAP,
18 INTERCEPTORS CHEMICAL HOLDING TANK X $6.00 =
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
MISCELLANEOUS PLUMBING
20 FIXTURE X $6.00 =
21 PRIVATE SEWAGE DISPOSAL/SYS X $20.00 =
INDUSTRIAL WASTE
22 INTERCEPTOR X_ $15.00 =
SUBTOTAL
METHOD OF PAYMENT:
PROCESSING FEE
❑ CASH 0 CHECK 0 VISA 0 MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
,#� MECHANICAL PERMIT APPLICATION Community Development Department
�;;;k��\ Building Division
i'7,VL° '`- Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
iii
Vd1R� For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City State Zip Code
Contractor: 5`-rU,g,WI 4,&rl 14 G License#: Phone#:
Mailing Address:
City State Zip Code
DESCRIPTION OF WORK #OF UNITS X COST = TOTAL AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 $ X $12.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X , $15.00 =
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 =
5 USED APPLIANCE(WSEC min.AFUE rating) Equal to or less than 400,000 X $50.00 =
6 USED APPLIANCE(WSEC min.AFUE rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $12.00 = ,
8 BOILER/REFRIGERATION 101 -500M BTU X $20.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $25.00 = ,
10 BOILER/REFRIGERATION 1,001 -1,750M BTU X $35.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $60.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE I X $10.00 =
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER I X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 3 X $1.00 `
=
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS LI 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 $15.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD I X $10.00 = ,
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 3-15 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 $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X• $25.00 =
33 REPAIR&ADDITIONS •
X $15.00 =
34 VENTILATION SYSTEMS X $12.00 =
35 VENTILATION MECHANICAL EXHAUST X $12.00 =
36 INCINERATOR-RESIDENCE X $19.00 =
37 INCINERATOR-COMMERCIAL X $22.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
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. ItA , This site plan is being submitted for the purpose of
obtaining a building permit and is a true and correct
bt representation of the pr•posal. All known property
i ,. lines/dimensions,c rb r ' •= uct es and easements
Whave been id=nti -•/ • in•'. are wetlands,
ICiEll bodies of "f- er, /, , • � critical areas.
p �.
tV g 8t2 Signed: _ � .
Date: if TAW
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