2003, 06-30 Permit App: BD03-713 Residence bgY-ooh
Fix
City of b ?S 0 °
SPOKANE VALLEY
PERMIT #
BUILDING PERMIT APPLICATION
Box 1 OWNER JOB LOCATION '.71.-110 / . 1z11..
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB 4l.end'"1?:t/ kjN,t_
THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. r
BOX 2 CONTRACTOR'S NAME C-1-3 sC r i`Z w1'l) HONE - ?Q-7733
CONTRACTORS ADDRESS 1/657.45 t . ttITY -t.
CONTRACTOR'S REG.# CA-U/0Sc. JQ'I ie-t" EXPIRATION DATE
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT 1 PHONE „ '-
ADDRESS t (0-77,0 � �G,l�-�9�%; 'dw�"CITY �' �=.�"y ZIP 44'05 7
BOX 4 SEWER AVAILABILITY y-eA WATER AVAILABILIT'1 .
BOX 5 ESTIMATED PROJECT COST$ EXISTING BLDG. VALUATION $
BOX 6 PROPERTY TAX ACCOUNT NUMBER Lo-r Z tL K Zp WoryO r mi 194(?-1<s,
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
CENSUS NUMBER LOT NUMBER
BOX 7 BUILDING SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR /153 2ND FLOOR
3RD FLOOR / OTHER q)' / BASEMENT FINISHED --a—/
BASEMENT UNFINISHED SZ.0/ DECK 8O / GARAGE SZo / I
CARPORT / TOTAL 1(053 / HEIGHT TO PEAK OF BUILDING FT.
BOX 8 ( ✓) SINGLE FAMILY ( W 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.
-1c
BOX 10 Water Service meter size(if known) 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 P -JURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
CORRECT TO THE BEST OF MY I LE GE ND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
ABOVE PREMISES T• P -F0", H W'aRK 'OR WHICH THE APPLICATION IS MADE.
OWNER/AGENT /:, -7/ DATE (0---3O O3 (OVER)
// V
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
YaT Ir' 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
^-' ne Spokane ValleValle ,WA 99206
,,,,,.•f y Y 509-688-0037-Fax
For Inspections, call 509-688-0054
-Mechanical Permit Application
PROJECT
ADDRESS: (,� )/� / �j PERMIT
ADDRESS:
/ /O ` �/ :
PHONEUSE (Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIT)
CONTRACTOR:
e___ LICENSE#:
MAILING ADDRESS: PHONE#:
•
(street) (city/state)
(ZIP)
DESCRIPTION OF WORK #OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE .OR<100,000
2 FUEL BURNING APPLIANCE X $19 /�
>100'000 X $19
3 UNLISTED APPLIANCE(ADDITIONAL FEE) •OR<400,000
X $50
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X X $ 0
$50
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000
7 BOILER/REFRIGERATION X $1 .
1-IOOMBTU X S155
8 BOILER/REFRIGERATION 101-500M BTU
9 BOIL[R/REFRIGERATION X $28
501-1,000M BTU X $39
10 BOILER/REFRIGERATION 1001-1,750M BTU `
11 BOILER/REFRIGERATION +1750M BTUX $57 ..X $95
12 GAS LOG,GAS INSERT,GAS FIREPLACE
13 RANGE X $10
— X $10
14 DRYER — i X $10 - -0
15 FUEL BURNING WATER HEATER — + X $10
16 MISC FUEL BURNING APPL. — X $10
17 GAS PIPING(ea.Outlet) — Z, X $1 a.
18 DUCT SYSTEMS — X $10
19 VENTILATING FANS — 1 X $10 . .c'3 0
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 t X $10 . /n
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 -
30 LPG STORAGE TANK — X 510 -
31 WOOD OR PELLET STOVE/INSERT — X $10
32 WOOD STOVE-FREE STANDING — X $25 =
SUBTOTAL: .77-0°
METHOD OF PAYMENT PLUS PROCESSING FEE:
fie.." TOTAL PERMIT FEE DUE:
0 CASH 0 CHECK 0 Mini 0 —.._.s
DATE: EXPIRES:
BANKCARD NUMBER
AUTHORIZED SIGNATURE:
art ,/� rrr„t 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
Sp ne Spokane Valley,WA 99206 509-688-0037-Fax
Walley . For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: ? Lilo £ J Z USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR:T1oft
ray'S pt...4.44ntovy‘i LICENSE It:
MAILING ADDRESS: PHONE It:
(street) (city/state) (GI') -
PLUMBING FIXTURES
DESCRIPTION DETAILS It OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS Z X $6 - I
2 URINALS X $6
3 TUBS % X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT I X $6Ce
5 SINKS LAVS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- 3 X $6 - SiRAY,FOOD,PREP/CULINARY/MEAT �j
6 DISHWASHER 1 X $6 -
7 CLOTHES WASHER I X $6 - le
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 - P Q
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 $6 -
RP.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL X $6 -
HOLDING TANK •
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL: /2. ,c()
F,THOD OF PAYMENT •C
VISA • •Vast PLUS PROCESSING FEE: �$,35.A9-'
CASH ❑ CHECK ❑ =MN ❑ -- 1..•1: -
TOTAL PERMIT FEE DUE:
TE: EXPIRES:
NKCARD NUMBER
THORIZED SIGNATURE:
APPROVED B
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