2004, 08-23 Permit App: BLD-04-07416 Residence Salvor BUILDING PERMIT APPneLICATION WORKSHEET
City of Spokane Valley Community Development Department
o
Building Division
e 11707 E. Sprague Avenue, Suite 106
.,,,..,,io va 1 1
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: \\°'\ %- ' ., \3sx\
Assessor's Tax Parcel Number(s): NS`\. \Sr , � \c1/4
Legal Description: \-..,c: \� Civ t. \.\\,,. R r,
PERMIT DESCRIPTION:
[j Building Permit ❑ Change in Use ❑ Grading ❑ Manufactured Home
❑ Relocation 0 Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
IA Owner: moi, ,\dad C,_,,•\ ❑ Applicant:
Phone:��\_ ,4s., Fax: <N\ka . Phone: Fax:
Address: .- TS ,1 c,« cAddress:
City State Zip Code City State Zip Code
❑ Contractor: -.,,, • ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City - State Zip Code
WA State Contractor License#:\�c•tN c�._- .� Contact: c_____\-,
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
MAIN FLOOR TO SQ. FTG: 21.4u FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTC: GARAGE S
Q. FTG: DECK/GOV. PATIO SQ. FTG:
`
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE:
ccz.v
#OF BEDROOMS:
TOTAL HABITABLE SPACE: IMPERVIOUS SURFACE AREA:
\\`‘.- )..\-.-'
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWER OR ON-SITE SEPTIC
c ,(.. - SYSTEM? S,,..„�o,�,C
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
Q BOLTING ❑ CONCRETE ❑ 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 ❑ Mastercard ❑ VISA ❑ Other
Bankcard#: Expires: VIN#:
Authorized Signature:
SM1'( 4s"�a,,� 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
polkane Spokane Valley, WA 99206 509-688-0037-Fax
4000Ualley 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) (city/state) (ZIP)
DESCRIPTION OF WORK IOFUNITS X COST EQUALS AMOUNT
1 FUEL BJRNING APPLIANCE •OR<100,000 \ X $15 -
2 FUEL BURNING APPLIANCE >100,000 X $19 •
3 UNLISTED APPLIANCE(ADDITIONAL FEE) -OR<400,000 X $50 •
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X $100 -
5 USED APPLIANCE(WSEC min.AFUE rating) -or<400,000 X $50 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X $100 -
7 BOILERJREFRIGERATION 1-100MBTU X $15 •
8 BOILER/REFRIGERATION 101-500MBTU X $28 •
9 BOILER7EFRIGERATION 501-1,000MBTU X S39 •
10 BOILER/YEFRIGERATION 1001-1,750M BTU X $57 -
11 BOILERil F.FRIGERATION +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 -
16 MISC.FUEL BURNING APPL. - X $10 •
17 GAS PIPING(ea.Outlet) - X $1 •
18 DUCT SYSTEMS - X $10 -
19 VENTILATING FANS - �. X $10
20 AIR HANDLER(DOES NOT Include ducting) •OR<10,000CFM X $12 •
21 AIR HA N DL ER(DOES NOT include ducting) >10,000 CFM X $19
22 EVAPORATIVE COOLERS - X $10 -
23 TYPE I HOOD - X $50 -
24 TYPE II HOOD - X $10 -
25 HEAT PUMP/AIR CONDI'T'IONER 0-3 TON , X S12 •
26 AIR CONDITIONER 3-15 TON X S20 •
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 WOOF.OR PELLET STOVE/INSERT - X $10
•
32 WOOD STOVE-FREE STANDING - X $25 •
SUBTOTAL
MET:'(,-)D OF PAYMENT PLUS PROCESSING FEE: 535.00
V iEr,�;1;_iif TOTAL PERMIT FEE DUE
C -i ElCHECK (T1 MEM EJ .___:.....::--.,4..
DAT: EXPIRES:
BANIKCARD NUMBER:
A.1,7,,,-,.c,-rn,-.1 .-.-
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STr,•,i 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
Valley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: \\��( .?_ \- \...t USE:
OWNER: PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: LICENSE 5:
MAILING ADDRESS: PHONE S:
(street) (city/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS S OF UNITS X COST EQUALS AMOUNT •
1 TOILEn WATER CLOSET,BIDETS X $05 -
2 URINALS X $6 -
3 TUBS \ X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT Z X $6 -
5 SINKS LAVSBASINS,BAR FLOOR KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- S X 46 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER \ X $6 -
7 CLOTHES WASHER \ X s6 -
8 GARBAGE DISPOSAL X $6 -
9 WATER SOFTENER X $6 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X $6 -
r
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE \ X $6 -
12 FOUNTAINS,DRINKING X $6 -
13 WATER PIPING/DRAIN-IN INSTALLATION,ALTERATION,REPAIR, .
WAS IE.,VENT,PLUMBING REVERSALS X E6 -
REVERSAL
14 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6 -
15 WATER USING DEVICE ICE AND/OR COFFEE MAKER,HOSE BIB,
SI E.AMER,PROOFER,CARBONATOR X $6 -
SWAMP COOLER
16 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK VALVE,AND X
-
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYS I EM X $25 -
8 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL • X
HOLDING TANK
9 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
0 MISC.PLUMBING FIXTURE X $6 -
SUBTOTAL:
(ET HOD OF PAYMENT
INNIMMI• VISA* ltGz5k� +' PLUS PROCESSING FEE: $35.00
] CASH ❑ CHECK ❑ EEO= o L___.... ..‘..1
TOTAL PERMIT FEE DUE:
ATE: _. EXPIRES:
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UTHOF rZEI GNATURE:
443t.Ott
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SWALff 'SEC110N` C-
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SWALE C-1 •
13TH AVENUE:
(2) CURB DROPS
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W/ 2'-9" OPENINGS `r'N
(3) CURB DROPS o u w-
W/ 4' OPENINGS ~ d .`�"d
EL = 2059.13".�,i ` I— 9.10'_ — incl•
i \ 5� O' TYP
I EL = 2059.40 i� II 1 — x_17/\ �
STA 2+95.00 I yr ' �7.5' SWALE C-2
r..l = 2059.53 - . \ �1 "208" SWALE I 1 S0'
BOTT EL = 2056.00 DRAINAGE
I, _ • "'_ H _ ,B OTT AREA = b25 S.F.. -� . . . . EASEMENT
'208' SWALE
0 BOTT EL = 2058.00
BOTT AREA - 590 S.F.
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SWALE SECTION C-1 ��e�� �',17.4/:,.a �
0 5 30 60 \\�� ,. \‘.. C\" '.4I' 1f Y J
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VALLEY PINES SUBDIVISION ,� ,, �,
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1 inch = 30 ft. LOT 18 - BLOCK 1 EXPIRES 12A 00
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HAI-IN ENGINEERING N. 8623 SUITE B DIVISION SPOKANE, WA. 99208o
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