2004, 06-30 Permit App: BLD-04-07010 Residence BUILDING PERMIT APPLICATION WORKSHEET
6poR°t~I'f1 City of Spokane Valley Community Development Department
. e g Buildin Division
.00017alle11707 E. Sprague Avenue, Suite 106
evSpokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION , ,4
Street Address: / .il Z 7 Lin L_Ot C.... , k e l(•y L k s v L 4,, UA l ie y i `i r 03''l
Assessor's Tax Parcel Number(s): 4 s Z/</, 3 7 0 Cr
Legal Description: LUT 9 , G Loc.Ic. 2, / i.,e / /e y L r ke FO CA V'.11 A-cl7t CO
PERMIT DESCRIPTION: A. iv c k ‹; `}..( I.eA
I i I l),:.cc -y0 e,-z`1; (•• /'3 .r1. �' Ai-i- Gri 7'
® Building Permit 0 Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
EX owiGfacf.2 5i. 7,Vhite, Ittc. ❑ Applicant: '5 a.-,..
Phone: q r-9 Fax: -.. :44,2:742 Phone: Fax:
Addy Address:
s'� � 4,/}L 99019
City StateZip c C n IT \--C State Zip Code
Contractor: s r'i ,wt D (g chitect:
Phone: Fax: f. jun3z 2004 one: Fax:
Address: cess:
City State lipedti L D Q N State Zip Code
WA State Contractor License #: el eo r91/i.-c> &9/PP, Contact: T c y r y QLu e t vUcP,
21. c,762,- Pyr },.
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: 2.E + DIMENSIONS: P i #OF STORIES: i
MAIN FLOOR TO SQ. FTG: t ate 2"1'FLOOR SQ. FTG: 14/14‘ ' UNFIN BASEMENT SQ. FTG:764
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
ti 4"4/ ef9 , 2-0s� I sic
OCCUPANCY GROUP: ex3 CONSTRUCTION TYPE: 5g HEAT SOURCE: Foix€i'). 4 rr.
CSR%
#OF BEDROOMS: TOTAL HABITABLESPACE: IMPERVIOUS SURFACE AREA:
-3 2-857
COST OF PROJECT: 16,a cea30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
IQ onkle SYSTEM? Sewer-
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 0 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 per2i_t_inuce to the property owner.
Print Name Mt r'1' R Signature
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash [kCheck El Mastercard El VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
MECHANICAL PERMIT APPLICATION
SanOlanigilli/e\IIIIft
\r/ City of Spokane Valley Community Development Department
BuildingDivision
= T _naj� 11707 E. Sprague Avenue, Suite 106
4,,,,,P°
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: 110 ii 2 7 7 L tnAt. c 4.(y i.k Permit Use: Pg C�i - t(A w/c 11 r A1-t- G o r,
Owner: o ‘e. tt,- , \Ji 4 ‘-f ,r ,- w 15 0 --.1 Phone(Daytime Contact): .:i2/ 9 74-2---
Mailing
_Mailing Address: -re r r`�( Zip Code
- George `1. hi.tInc.. ,
Contractor. City State
License#: T,-) A ; X.`- 9; i r Phone#: '3 2t /74'2_
Mailing Address: '-O 1,.?, State Zip code
rs'<
city
-lfri�,�'��:,?"_�a °�,cx, ,. . 9,20_10 #OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 / X $15.00 = I S
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 UNUSTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(WSEC min.AFUE X $� =
5 rating) Equal to or less than 400,000
USED APPLIANCE(WSEC min.AFUE X $100.00 =
6 rating) More than 400,000
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 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 _
12 GAS LOG,GAS INSERT,GAS FIREPLACE I X $10.00 = /O
13 RANGE I , X $10.00 = /0
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER / X $10.00 = / 0.
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 = 2.
18 DUCT SYSTEMSX $10.00 =
19 VENTILATING FANS .5 X $10.00 = -S-CD
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 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD / X $10.00 = / 0,
25 HEAT PUMP/AIR CONDITIONER 0-3 TON I X $12.00 _= / 1 r
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 =
METHOD OF PAYMENT:
SUBTOTAL ) I tel•° cV
0 CASHHECK 0 VISA OMC
DATE: PROCESSING FEE $35.00
EXPIRES: ''TOTAL PERMIT FEE DUE: I S�{•00
CARD#:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
SfioorkanOiel\IIII% City of Spokane Valley Community Development Department
BuildingDivision
11707 E. Sprague Avenue, Suite 106
V Spokane Valley, WA 99206
�1 Phone: (509)688-0036;Fax: (509)688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: 1‘,2/2"� `? ' Lr � k tJyL,) Permit Use: Or!S r R 4-etcLI Cor Artr,
Owner: --„ =; UI '�( .< } �'c `% " Phone (Daytime Contact): 9Z/ 9 75.
Mailing Address: CS e LII. fiite, Inc. -"`e rry�
sa? ,T 52 City State Zip Code
Contractor. Li f License#• ea r> h 1.0 i Phone#: 92/2/,� . 9019
Mailing Address:
City State Zip Code
*OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 = f�.
2 URINALS X $6.00
3 TUBS ] X $6.00 = I .
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X $6.00 = (p
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD, /-
PREP/CULINARY/MEAT (A '
6 DISHWASHER ) X $6.00 = Co
7 CLOTHES WASHER k X $6.00 =
8 GARBAGE DISPOSAL 1 X $6.00 = Cc) ,
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 I CC=
12 ROOF DRAINS/OVERFLOW DRAINS X $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
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 ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, i X $6.00 = 2 44
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 )2 6).0 2
0 CASH DoCHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE EXPIRES: TOTAL PERMIT FEE DUE: i (G 0 0
BANKCARD NUMBER i
AUTHORIZED SIGNATURE:
r ,
Ai:, , 12-111S(I&
.,
s P O K A N E 1::::1 4,1-4 n..:., �u C O U N T Y
UTILITIES DIVISION A DIVISION OF THE PUBLIC WORKS DEPARTMENT
N.Bruce Rawls,P.E.,Utilities Director Lk5i3Z)
GENERAL FACILITIES CHARGE (GFC) /
PAYMENT OPTION SELECTION RECORDt)j(
PLEASE NOTE: Form must be filled out accurately and in its entirety,and signed,or a permit will not be issued.
Date: ...30 S hi U
Plat Name: S ke. t`-€f I._ \<. . Lot No(s): ct Block No(s): Z-
Site Address(es): 1 ( Li 2 7 c'I I_ L A Ne_. Parcel No(s): y 2J _=
Owner Name: S tA vv‘ OR Builder Name: CDP?o ,rcie 0 . \.J L fe --k-NC-..
PRINT Owner's Name PRINT Builder's Name
Payment Option Selected (Check One):
1. ❑ GFC payment received at issuance of Sewer Connection Permit by
Division of Utilities
2. RI GFC to be paid at closing. See Special Conditions below regarding GFC rate.
(6y s c u_e(r ( a,(-1, i .J
3. ❑ GFC payment in 24 equal monthly payments upon establishment of Sewer Billing Account.
See Special Conditions below regarding GFC rate.
If Option No. 3 is selected, complete one of the following statements:
a. Owner's Statement: I, , understand that I will be
billed for the applicable GFC amount in 24 monthly installments. The monthly GFC installments will be added
to my monthly sewer service charges.
b. Builder's Statement: I, understand that because I
am selecting this option for payment of the GFC, the purchaser of the home will be responsible for payment of
the applicable GFC in 24 equal monthly installments. I agree to formally disclose to potential buyers of the
property that the GFC charges will be added to the monthly sewer service billings as soon as billing
commences.
Special Conditions: Sewer connection permits are valid for 12 months from date of issue. If final connection is
not completed and inspected within the 12-month life of the permit, a new permit will be required and the GFC rate
that is in effect when the new permit is issued will apply.
Other Special Conditions: ❑ No Yes - See Reverse Side of Form
—,-k_ 5 41'7 C iii 0
Owne or uilder's Signature C° `4 `') :-.t-'-4C--- Date
Located at: 1026 W.Broadway, 4th Floor
SpokanePayment Option Form, Revised 02-04-04
Spokane County, Division of Utiliiiuz6 W. Broadway • Spokane, WA 99260:U430
( no) d77-1Ana. • FAX. (.5091 477-4715 • TDD: (509) 477-7133
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and assoronla
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ROA WIpTH NNp dam ar oMwr�t�cal areas.
F oat __i LANKNc�_____,_
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CO MEN18 Date:
REVI ED 8Y INFO_, , , . A
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