2004, 06-16 Permit App: BLD-04-04616 Residence BUILDING PERMIT APPLICATION WORKSHEET
crn'oF SpokaneCity of Spokane Valley Community Development Department
Building Division
'
40000ValleY
11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: ,t-/D ID' E _..
Assessor's Tax Parcel Number(s): -16:,/13. A )c 3
Legal Description: Tr ct 'C S i d r f Plat o o --a'3
r
PERMIT DESCRIPTION: Ai-Pc-0C.d to 10.A,GTf 1 d A
g 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
NContractor: wWirtz zrL Wi CDAar IA/G. ❑ Architect:
Phone: 2qq-49c.q Fax: zq1-(044 Phone: Fax:
Address: 1o403 S. ceaacrrt /e, Address:
MFt rciu ZAKE I./ASN 9f022
City State Zip Code City State Zip Code
e` \v)-1)/0 417 .Y-/
WA State Contractor L'cepr se #: Wyrrr g74 NS Contact:
46)441a',
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: c 1 A- DIMENSIONS aX36- #OF STORIES: /
MAIN FLOOR TO SQ. FTG: 2""FLOOR 940 SQ. FTG:6 UNFIN BASEMENT SQ. FTG
FINISHED BASEMENT SQ.FTG: GARAGE SQ. FTG: DECK/COV. PATIO SQ. FTG:
OCQUMNCY OUP: CONSTRUCTION TYPE: H T SOURCE:
5/L 4 F�(ly CO�o ( s
#OF BROOMS: TOTAL HABITABLE SPAC : IMPERVIOUS SURFACE AREA:
COST OF PROJECT: 30% SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC-/
0 SYSTEM? S /Yf - S y5Tri14
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
El BOLTING El CONCRETE El 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 El Mastercard ❑ VISA
❑ Other
Bankcard #: Expires: VIN#:
Authorized Signature:
•
Inspections performed 10 days after
scheduled completion to schedule call
(509)688-0195 or Fax(509)688-0037. Any re-
inspection will incur an additional $25.00
charge.
11707 E Sprague Ave, Suite 106
400000,
Spokane Valley,WA 99206
ROW Construction Permit
Permit# ROW 04-409 Issue Date 6/16/2004 Account#
Completion Date Issued by Construction Utility
Location of Property Project Description
14310 E 10th AVE driveway
Comments
New construction of driveway
Trench Dimensions AC Cut Required
Applicant/Contractor Name Licence# Individual Name
White Water Construction
Address Contractor Phone#
10403 S Granite Dr
Medical Lake WA 99022-
Account#
Permit Fee Inspection Fee Total Fees Collected
$25.00 $25.00 $50.00
Permittee Signature Approved Date
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Credit Card# Expiration Date
Name of Holder Signature
In addition to the permit application fee of$16.00(utility)or$25.00(construction), inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(signed) Date
PERMIT MUST BE KEPT ON SITE
•
PLUMBING PERMIT APPLICATION
0#\IICity of Spokane Valley Community Development Department
BuildingDivision
galley 11707 E. Sprague Avenue, Suite 106
del
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: f Permit Use:
Owner: /A-1.‘,1 P �,t�a -�e v Cc1. ! ut c. Phone (Daytime Contact): ,299-4-9.(c,
Mailing Address: /04O 3 S_ �isck je Dr, )'liVet,cGiL Lt/6-e Wu- 96102-
( City State Zip Code
Contractor: F(A.C-e'fs -N- STc t License#: �c�(.�c e t5' 31Phone#:
Mailing Address: P.o. Qd c 5p041Lt. 04(1,e) cock `.?7
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS X $6.00 =
2 URINALS X $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAVSBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,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, X $6.00 =
CONDENSATE _
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 J X $6.00 =
16 WATER USING DEVICE ICE AN/OR 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
Q CASH 0 CHECK Q VISA Q MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
MECHANICAL PERMIT APPLICATION
*l^ „e104.°\ftiCity of Spokane Valley Community Development Department
ane BuildingDivision
le
Y 11707 E. Sprague: Avenue, Suite 106
..•OVal
Spokane Valley, WA 99206
Phone (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address(( Permit Use:
Owner: LAA 1 L. ti/A_ L'G►.51%. (Ac., Phone (Daytime Contact):
Mailing Address: k,46 4 c . 64,40 ti-..e flr, t4 J c�-r kok-e foci . fye,22-
City State Zip Code
Contractor: n ..., I i bAL License#: Phone#:
Mailing Address: 16.6. , )ii /, 4(, ( , 9D2
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL.BURNING APPLIANCE Equal to or less than 100,000 r 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 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 _
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 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 / 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
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD
l X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON i 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 =
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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This ells plan is being submitted for the purpose of
obtaining a building womb and is a 1[w and correct
fines/dimensions.euro known property
have t identified. easementsllands
bodies of indicated are w ,
edands
�!p , . Or other critical aeras.
Signed- e( -- %v
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