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2003, 06-30 Permit App: BD03-719 Residence Egg-©o 3 L F/q x b sS 62 ° -5/ City of SPOKANE VALLEY PERMIT # '7/ 1 BUILDING PERMIT APPLICATION° Box 1 OWNER JOB LOCATION "1 0 GI 61 ?ice OWNER'S ADDRESS CITY PHONE DESCRIBE JOB (ZQS)DP," 1 kareJ-• • THIS PROPERTY IS OWNED BY: SINGLE/MARRIED °r/ PARTNERSHIP CORP. BOX 2 CONTRACTOR'S NAME e.W 4iy►^ Sa- PHONE qqq 77 3 3 CONTRACTOR'S ADDRESS 1(QS ZO 4-4.-rWITY Ve/R41-0 CONTRACTOR'S REG.# [C"I Se- l o q R r EXPIRATION DATE / -U (CARD MUST BE PRESENTED AND COPIED OR VERIFIED) BOX 3 CONTACT PERSON OF PROJECT PHONE gif9-7 733 ADDRESS S14)-4V‘4" CITY 5Y N-E.. ZIP BOX 4 SEWER AVAILABILITY P'› WATER AVAILABILITY .. BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION$ BOX 6 PROPERTY TAX ACCOUNT NUMBER v r //�� LEGAL DESCRIPTION k-OT Z3 Q -1C z W 0b•b2._ AJ n1 /"090K (IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION) CENSUS NUMBER LOT NUMBER BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR (133/ 2ND FLOOR 8-/ 3RD FLOOR .�" / OTHER / BASEMENT FINISHED / BASEMENT UNFINISHED SZ-e) / DECK gd / GARAGE SZS))/ c, CARPORT �� / TOTAL 41C2., / HEIGHT TO PEAK OF BUILDING I d FT. BOX 8 ( SINGLE FAMILY ( 1--NIEW CONSTRUCTION ( ) MULTIFAMILY(NO. OF UNITS ) ( ) EXISTING STRUCTURE ( ) COMMERCIAL/INDUSTRIAL TOTAL AREA OF PROPERTY SQ. FT. ( ) TENANT IMPROVEMENT IMPERVIOUS SURFACE SQ. FT. BOX 9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES PLEASE USE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES, SYSTEMS, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS, LAWN SPRINKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL. BOX 10 Water Service meter size(if known) 1 Also see BOX 4 BOX 11 Septic Tank-Not generally allowed in the City of Spokane Valley. For special circumstances contact Your sewer purveyor and the Health District (See BOX 4) BOX 12 Street use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public Works Department. I VERIFY UNDER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND CORRECT TO THE BEST OF MY 0 EDGE A• D FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE ABOVE PREMISES TO P -F0- ' H. IP -K F9: a HICH THE APPLICATION IS MADE. /_ OWNER/AGENT WA( IAfial DATE 6-3O^ (OVER) • I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card: Visa Mastercard ____ ____ Expiration Date Print the name of the Holder Signature DO NOT PLACE ANY BUILDING UNDER POWER LINES OR OVER INCOMING GAS LINES. OFFICE USE ONLY- PLEASE DO NOT WRITE BELOW THIS LINE ZONE SETBACKS: FRONT SIDE REAR HEIGHT LIMIT PLANNING DEPARTMENT APPROVAL DISAPPROVAL DATE REMARKS SEPA: EXEMPT NOT EXEMPT FIRE DEPARTMENT APPROVAL DISAPPROVAL DATE REMARKS PUBLIC WORKS DEPARTMENT APPROVAL DISAPPROVAL DATE TYPE OF JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL IND.ADD/ALT NEW COMMERCIAL COMM.ALT/ADD NEW MULTIFAMILY NO. UNITS MULTIFAMILY ADD/ALT TENANT IMP. ROOF OTHER OCCUPANCY TYPE OF CONSTRUCTION STORIES BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ _ BUILDING SQ. FT. @ - BUILDING SQ. FT. @ _ TOTAL SQ. FT. TOTAL VALUATION BUILDING PERMIT NO. PLAN CHECK FEE REC'D RECEIPT NUMBER PERMIT FEE PLAN CHECK FEE _ PLUMBING FEE MECH. FEE TOTAL FEES WSBCC SURCHARGE ENERGY SURCHARGE OTHER CHARGES AMOUNT DUE BUILDING DEPARTMENT APPROVAL BY DATE ASSIGNED ADDRESS Received sin t 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone POliane Spokane Valley,WA 99206 509-688-0037-Fax ....*Valley. For Inspections, call 509-688-0054 Mechanical Permit Application PROJECT y> PERMIT ADDRESS: 7 qD _1 L i ez USE: OWNER PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) CONTRACTOR: n ^()'(/ ~ f LICENSE A: MAILING ADDRESS: } � PHONE ft: (street) (city/state) (ZIP) DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT 1 FUEL BURNING APPLIANCE .OR<100,000 / X $15 2 FUEL BURNING APPLIANCE >100,000 X $19 3 UNLISTED APPLIANCE(ADDMONAL FEE) •OR<400,000 X 550 4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 5 USED APPLIANCE(WSEC min.AFUE rating) .or<400,000 X 550 6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 7 BOILER/REFRIGERATION 1-100M ETU X $15 - 8 BOILER/REFRIGERATION 101-500M BTU X $28 . 9 BOILER/REFRIGERATION 501-1,000M BTU X $39 10 BOILER/REFRIGERATION ' 1001-1,750M BTU X $57 . 11 BOILER/REFRIGERATION +1750M BTU X $95 12 GAS LOG,GAS INSERT,GAS FIREPLACE - X 510 13 RANGE . X $10 14 DRYER - f X $10 . 15 FUEL BURNING WATER HEATER 1 X 510 16 MISC FUEL BURNING APPL. - X $10 17 GAS PIPING(ea.Outlet) - 2., X $1 18 DUCE SYSTEMS - X $10 19 VENTILATING FANS - 3 X 510 - 20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM X $12 21 AIR HANDLER(DOES NOT include ducting) >10,000 CFM X $19 22 EVAPORATIVE COOLERS - X $10 23 TYPE I HOOD X $50 . 24 TYPE II HOOD - I X $10 25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12 26 AIR CONDITIONER 3-15 TON X $20 ` 27 AIR CONDITIONER 15-30 TON X $25 - 28 AIR CONDITIONER 30-50 TON X $35 29 AIR CONDITIONER +50 TON X $60 30 LPG STORAGE TANK - X $10 - 31 WOOD OR PELLET STOVE/INSERT - _ X 510 . 32 WOOD STOVE-FREE STANDING - X $25 . SUBTOTAL: -7 METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00 MOM. r it�'f {.' • TOTAL PERMIT FEE DUE: 0 CASH 0 CHECK 0 Mini 0 `_-.._'' :'_ DATE: EXPIRES: • BANKCARD NUMBER: AUTHORIZED SIGNATURE: 0!4�� ♦ 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone Spo ne Spokane Valley,WA 99206 509-688-0037-Fax Walley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: 7 !VL/ £- 1 V USE: OWNER: !V PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) LICENSE : CONTRACTOR: ,+D imLt‘5 ptuohLin, PHONE t# MAILING ADDRESS:SS (street) (city/state) (ZIP) ' PLUMBING FIXTURES DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT 1 TOILETS WATER CLOSET,BIDETS 7i X $6 - 2 URINALS X $6 - 3 TUBS i X $6 - 4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 1 X $6 5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN, LAUNDRY,UTILITY,JANITOR,PHOTO,X- 3 X $6 - • RAY,FOOD,PREP/CULINARY/MEAT _ 6 DISHWASHER X $6 7 CLOTHES WASHER I X $6 - 8 GARBAGE DISPOSAL X $6 - 9 WATER SOFTENER X $6 - 10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 - 11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE 1 X $6 - 12 FOUNTAINS,DRINKING X $6 - 13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR WASTE,VENT,PLUMBING. 'REVERSALS X $6 - REVERSAL 14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 - 15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB, STEAMER,PROOFER,CARBONATOR, X $6 - SWAMP COOLER 16 CROSS CONNECTION DEVICE VACUUM BREAKER CHECK VALVE,AND X RP.B.P.D.FOR:VATS,TANKS,BOILERS 17 SPRINKLER SYSTEM X $25 - 18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X - HOLDING TANK 19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 - 20 MISC.PLUMBING FIXTURE X $6• - SUBTOTAL: 3THOD OF PAYMENT -7.2' ammo •'f( .5 PLUS PROCESSING FEE: ,$3&6 ' CASH ❑ CHECK ❑ MOM ❑ ..._ _L.-Z..; - TOTAL -_ - TOTAL PERMIT FEE DUE: TE: EXPIRES: NKCARD NUMBER: THORIZED SIGNATURE: APPROVED BY _ iI t ✓f I St") 1 1 e411) 11 i 10 LO Z3 gu ZO uooeL /i PSK 9Lto9 £ .t