2005, 01-14 Permit App: 05000149 Finish Basement o A i -hf
BUILDING PERMIT APPLICATION WORKSHEET
01 City of Spokane Valley Community Development Department
SCIll' kane g
Buildin Division
OValle 11707 E. Sprague Avenue, Suite 106
y Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: t S)i E, gill
Assessor's Tax Parcel Number(s):
Legal Description:
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PERMIT DESCRIPTION: .f, a i S irl bck- -v i-etA- (Jii 1 s hi rtJ q 50 -4)
Ni Building Permit E Change in Use n Grading n Manufactured Home
Relocation n Tenant Improvement ❑ Fire Safety — Other
OWNER/APPLICANT INFORMATION
❑ Owner: are V\ Gir`"`I ❑ Appjicant: (Zo b -E'F ;len b i
Phone: (-a13b Fax: P one Z5 i-052.E-j- ,)ax:
Address: x,025 E _ o -1.1 Ada_t .:l - 13 r-4xtc
u t it!, ok,c Y't - L,0 Pt- CA w
ity State Zip Code City State Zip Code
Contractor: AI ) j ia,Y. ' e 0.1.t -6` �._( Architect:
Phone asfro52.�- Fax: I Pr1,ie m.QvdPhone: Fax:
Address: 21 i?7 w - 13r vcAcl Address:
SL y s W t ct�c S
Cit State Zip Code City State Zip Code
WA State Contractor License #: A u__(= agei12MiContact: ?.p t 'f -tmbi�-
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
i fXOb
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: a s
#OF BEDROOMS: 2 TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
if 1 ?j I bq 7 3 SYSTEM? 5e,, ='W
MANUFACTURED HOME
Width: Length: Year: Pit Set:
Manufacturer:
r 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
I I BOLTING f CONCRETE REINFORCEMENT n 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 i ure to the property owier.
.�—
Print Name r1OZCLi (1,11,%A. LE Signature - / ' �►
Method of Payment: (Faxed permit applications will only be accepted with major bankcard)
❑ Cash [X Check ❑ Mastercard ❑ VISA ❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
PLUMBING PERMIT APPLICATION Community Development Department
Building Division
Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
[, lley For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
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Project Address: I ?-)02,c3- E E. q 1-1Permit Use:
Owner: Br -e*t-f -F1-e GA--e.j Phone (Daytime Contact): 6.1"-r1-7 e757
Mailing Address: ) 6 02._G S E 9 lA_M-- q`si 01 b
City State Zip Code
Contractor: ft I\ees,°o Ice_ g/.0..14,,, #Y1.'.Tor- It-Cense#: ( E}41'lM^( Phone#: 5/.11 2.5I `O'i2+
Mailing Address: 2 7 I i \A). BrVCcdk Seo F2ctr e ,k on2.4-/-5-
City State Zip Code
DESCRIPTION OF WORK X OF UNITS X COST = TOTAL AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6 00 =
2 URINALS _X $6 00 =
3 TUBS I X $6.00 = te.2' C.1)
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 X $6 00 =
7 CLOTHES WASHER X $6 00 = ,
8 GARBAGE DISPOSAL 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,CONDENSATE 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, �00i
14 VENT,PLUMBING,REVERSAL REVERSALS X $6 00 = , W
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 00 =
ICE AN/OR COFFEE MAKER,HOSE BIB,
16 WATER USING DEVICE STEAMER 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 DISPOSAUSYS X $20 00 _
INDUSTRIAL WASTE
22 INTERCEPTOR X_ $15 00 =
SUBTOTAL /,
METHOD OF PAYMENT: `` 2' 00
PROCESSING FEE
0 CASH ri CHECK ❑ VISA 0 MASTERCARD $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
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MECHANICAL PERMIT APPLICATION Community Development Department
�'
�L�� Phone: (509) 688-0036; FAX: (509) 688-0037 11707 E. Sprague Avenue, Suite 106
�d1 Building Division
For Inspections, Call (509) 688-0054 Spokane Valley, WA 99206
Project Address: Igt.)-2.:-S— Cl -fry Permit Use:
Owner: Phone (Daytime Contact): _
Mailing Address:
City State Zis Code
Contractor: License#: Phone#: —
Mailing Address:
crty State ZP 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 X $10 00 =
13 RANGE X $10 00 =
14 DRYER X $10 00 =
15 FUEL BURNING WATER HEATER X $10.00 =
16 MISC. FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) X $1.00 =
18 DUCT SYSTEMS X $10.00 =
19 VENTILATING FANS f X $10 00 = ) 0, 00
20 AIR HANDLER(DOES NOT inciude 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 $5000 =
24 TYPE II HOOD 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&ADDITIONSX $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 = 0 //��
METHOD OF PAYMENT: SUBTOTAL ( ' 00
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0 CASH CHECK 0 VISA 0 MC DATE PROCESSING FEE $35.00
CARD#
EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE.
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it ______ A_ l 5 _
41
r r �.....,,, ,. EMERGENCY LESS REQ�IIRE�ENTS ': •.
FROM S PING ROOMS N.
I s
KS 1)NET CLEAR OPENING ! 5.7 SOUAREPfsC ' E2GSs
1.324-�1vd(o GRADE FLOOR OPENING(MAX 44°) � 5.0 SQUARE FEET d��.l'`
2)NET CLEAR OPENING HEIGHT 24 INCHES
3)NET CLEAR OPENING WIDTH 20 INCHES
N 4)MAX FINISHED SILL HEIGHT 44'ABOVE FLOOR
?OLP,/ 5)EMERGENCY ESCAPE&RESCUE IIP,ENING SHALL BE THESE PL
wt.�,l. OPERATIONAL FROM THE INSIDE 0F1 E ROOM WITHOUT qNs M .
Smt4'E THE USE OF KEYS OR TOOLS Yl t; ✓ ST gE KEP
F/
ON T SIT T
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WHEN INTERIOR ALTERATIONS.REPAIRS OR ADOITIO %
I I , -REOUIRING, RMIT OCCUR,OR WHEN ONE/OR MOR -....-. ____
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1 ; i DWELLINGS.THE DWELLING DIRT SHAH DI PROVIDED ! —`' INGEXISTI (Q------\1-1-
U SMOKE ALARMS SF�ALL� E.f INTERCc)NWITH SMOKE ALARMS LOCATED AS RE D FOR t I NECTED AND HARD WIFIEO 'IN SUCH A }
DWELLINGS. z 2 / _ ; 1 MANNER THAT THE ACTIVATION OF ONE ,,
,��-/ ;• ALARM WILL ACTIVATE ALL ALARMS. ��
V. —,. ; _ ___� (BEDROOMS. AREAS APPROACHIN
,� ,r, BEDROOMS , VAULTED CEILLN
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`/ i , } WITH RISE OF 24. ON EACH FLOOR ` T.° =1I
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ION AND OPENINGS BETWEEN �u�
7 , ,AND PRIVATE GARAGE SHALL HAL:
1-1 `` �01c E I 4 j i r,.:,, r PROVE D FOR ONE HOUR FIRE RESISTIVE
a� r �eT3rGt02 �� ' C P. ,HE GARAGE SIDE:
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4A I CrA I ti)..;t' DE NCE/ATTIC,FLOOR/CEILING)
I to ��c, ..AGE AND RESIDENCE SHALL BE
µ :.,. f •;(q I., ,CI l'POOR,SOLID OR HONEYCOMB ',•i
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I,ti SAN i 3;8",OR 20 MINUTE FIRE RAT
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