2003, 10-31 Permit App: BLD-03-02972 Residence City of WO- 003(0
SPOKANE VALLEY fr( (phi('U037
PERMIT # 3L[) - 03 . C11( -11-
BUILDING
11(-1LBUILDING PERMIT APPLICATION
Box-1 OWNER \--\c�c., ,,= JOB LOCATION \\ .
OWNER'S ADDRESS CITY PHONE
DESCRIBE JOB .SC
•THIS PROPERTY IS OWNED BY: SINGLE/MARRIED
PARTNERSHIP CORP. J
BOX 2 CONTRACTOR'S NAME \--\\;-> �a cam\ PHONE c,,°\- -O
CONTR=ACTOR'S ADDRESS S. \Z C4__c\ CITY S4
CONTRACTOR'S REG.# \-\ck'\ c--1..0`-'\°\ C..- EXPIRATION DATE !
(CARD MUST BE PRESENTED AND COPIED OR VERIFIED)
BOX 3 CONTACT PERSON OF PROJECT C\-c , S Q PHONE
ADDRESS CITY ZIP
BOX 4 SEWER,AVAILABILITY WATER AVAILABILITY �'\���c 4
BOX 5 ESTIMATED PROJECT COST$ "\Sw'v EXISTING BLDG.VALUATION$
BOX 6 PROPER;Y TAX ACCOUNT NUMBER •
LEGAL DESCRIPTION
(IF NECESSARY, PLEASE SUBMIT A SEPARATE PAGE WITH THE LEGAL DESCRIPTION)
• CE;:SU N'.;MBER LOT NUMBER
BOX 7 BL _DING', SQUARE FOOTAGE (Existing/proposed) 1ST FLOOR \1j3 / 2ND FLOOR • /
3RD FLOOR / OTHER / BASEMENT FINISHED
BASEMENT UNFINISHED / DECK _ / GARAGE /
CANPOR / TOTAL / HEIGHT TO PEAK OF BUILDING \ FT.
30X 8 ( /) SIN NLE FAMILY -`"
( ) MULTIFAMILY(NO. OF UNITS ( NEW) CONSTRUCTION
( CC=�'•'.MERCIAL/ INDUSTRIAL ) � ( ) EXISTING STRUCTURE
( j T-: .ANT IMPROVEMENT •
TOTAL AREA OF PROPERTY \z\\:I SQ. FT. •
IMPERVIOUS SURFACE 1u�� I SQ. FT. •
30X9 PLUMBING FIXTURES (Including rough-ins) MECHANICAL APPLIANCES
PLEASE LSE THE ATTACHED PLUMBING/MECHANICAL FORM FOR THE LISTING OF ALL APPLIANCES,
SY. 1 E,1U, HEATING AND AIR UNITS, FIREPLACE INSERTS, WATER HEATERS, CONVERSION BURNERS,
LAV.N : i 'i NKLER SYSTEMS, BACK FLOW PREVENTERS, ET AL:
OX 10 .;er Service meter sizeif known)) Also see BOX 4
OX 11 .)tic Tank-Not generally allowed in the City of Spokane Valley. For special circumstances contact
Y^_ir sewer purveyor and the Health District (See BOX 4)
OX 12 S;;.et use may require a" Street Use Permit"for sewer, water, sidewalks, curb cuts. Contact the Public
-a Department.
/ERIFY U,`HER THE PENALTY OF PERJURY THAT THE INFORMATION FURNISHED BY ME IS TRUE AND
ORRECT 0 TI ... BEST OF MY KNOWLEDGE AND FURTHER THAT I AM AUTHORIZED BY THE OWNER OF THE
30VE PREIv1ISE ' TO PERFORM THE WORK FOR WHICH THE APPLICATION IS MADE.
NNER/AcEN _Ca) DATE (OVFF21
I et,v authorize the City of Spokane Valley to charge the fee for this permit.to credit edit card:
Vis.. lti,astercard
-- ---- ---- -- __ Expiration Date
Pri,.t .c name of the Holder
Signature
OFFICE USE ONLY-PLEASE DO NOT WRITE BELOW THIS LINE
--- --------
ZOh.::_ SETBgCKS: FRONT-
SIDE REAR HEIGHT LIMIT
FLAP . ; 3 DEPARTMENT APPROVAL
DISAPPROVAL
DATE
REM ,,=< ::; ---_—
•
•
SEPF,: EMPT .- NOT EXEMPT
FIRE \RTMENI{EAPPROVAL
' DISAPPROVAL
REM/=. .; DATE
PUBLI ; ,/c)RKS DEPARTMENT APPROVAL — ======================—
DISAPPROVAL
•__ DATE
TYPE c JOB: NEW RESIDENCE RES.ADD/ALT NEW INDUSTRIAL
IND.ADD/ALT_�—
NEW CC—. I, ERCIAL_ COMM.ALT/ADD
—.—_.NEW MULTIFAMILY NO. UNITS
MULTI[ LY ADD/ALT TENANT IMP.
ROOF OTHER
OCCUF Cy TYPE OF CONSTRUCTION
STORIES
BUILDING SQ. FT. @
_ _BUILDING SQ. FT. @
BUILDING SQ. FT. @ —
— BUILDING SQ. FT. @ —
TOTAL SQ. FT.
TOTAL VALUATION .
BUILDING PE ZMIT NO. PLAN CHECK FEE REC'D
RECEIPT NUMBER
PERMIT FEE PLAN CHECK FEE PLUMBING FEE
MECH. FEE
TOTAL FEES_ WSBCC SURCHARGE
• ENERGY SURCHARGE
OTHER "HA:?;ES ;I
•
AMOUNT DUE
BUILDING DE_;'ARTMFrNT APPROVAL .
. BY
DATE
ASSIGNED ADDRESS
•
•1
SaT' 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
On pSpokane Valley,WA 99206 509-688-0037-Fax
4.0r0Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: \\�� \\• ...1.\\..... USE:
OWNER:
PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR:
LICENSE it:
MAILING ADDRESS:
PHONE it:
(street) (city/state)
PLUMBING FIXTURES
DESCRIPTION DETAILS S OF UNITS X
1 TOILETS COST EQUALS AMOUNT CLOSET,BIDETS 3 X �
2 URINALS -
3 TUBS X $6 •
4 SHOWERS PER TRAP 7.. X $6 -
) BATH,STALL,ON-SITE BUILT \ X
i 5 SINKS LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- A X
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER
r 7 CLOTHES WASHER 1 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,COI,TRENCH, X $6 -
CONDENSATE \ X $6
12 FOUNTAINS,DRINKING -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, X
WASTE,VENT,PLUMBING REVERSALS •
REVERSAL X $6
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 -
6 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 -
7 SPRINKLER SYSTEM
18 INTERCEPTORS GREX $25 •
ASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X $6 -
19 MEDICAL GAS per outlet NITROUS,OXYGEN
20 MISC.PLUMBING FIXTURE X $6 -
X S6
IETHOD 01 .'AYMENT SUBTOTAL:
• I-------.......,
j . .ter..:_:
] CAST CHECK ❑ ❑ i__- LISA
. j PLUS PROCESSING FEE: $3g,pp
•
TOTAL PERMIT FEE DUE:
AT: ---- EXPIRES:
1NKCCA.RD NUMBER: `;^
UTHORIZED SIGNATURE: Gj��/J� V/
aI,,o•--.�Ir �mre� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
poane Spokane Valley,WA 99206 509-688-0037-Fax
Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS.
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE$:
MAILING ADDRESS. PHONE$:
(street) (dty/state) (ZIP)
DESCRIPTION OF WORK x 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(ADDITIONAL FEE) •OR<400,003 X $50 •
I
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 •
5 USED APPLIANCE(WSEC min.AFUE rating) •or<403,000 X $30 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 •
7 BOILER/REFRIGERATION 1-100M BTU X $15 •
8 BOILER/REFRIGERATION 101-500MBTU X $28 •
9 BOILER/REFRIGERATION 501-1,000M BTU X $39 •
10 BOILER/1:EFRIGERATION 1001•1,750M BTU X . $57 •
11 BOILER/REFRIGERATION +1750M BTU X $95 •
12 GAS LOG.GAS INSERT,GAS FIREPLACE - X $10 •
13 RANGE - X _ $10 •
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - ` X $10 -
15 MISC FUEL BURNING APPL. - X $10 •
17 GAS PIPING(ea.Outlet) - X $1 -
18 DUCT SYSTEMS - X $10 •
19 VENTILATING FANS - 4 X $10 -
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 S50 •
24 TYPE II HOOD - 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 525 •
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 $10 -
32 WOODS:OVE-FREE STANDING - X $25 -
SUBTOTAL
,LET )D OF PAYMENT PLUS PROCESSING FEE: $35.00 -
11111111111111111
VISA' rra.;6;tiif
TOTAL PERMIT FEE DUE:
❑ C..,1-1 ❑ CHECK ❑ MIMI 0 -,-.._
DATE. EXPIRES:
BAN}.: :ARD NUMBER:
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