2004, 01-27 Permit App: BLD-04-03464 Residence siaanoierN, . .
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
• Phone:(509)688-0036 Fax:(509)688-0037
1 REQUIRED SITE INFORMATION
1
STREET ADDRESS: '¢64 I sl— /74"--h
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: ili 1- F' /11E//// /,4 1
#AN. Tir,/r/17 617/ lei . /IOW
PERMIT D -ESCRIPTI .
digIDLDING.PERMIT °CHANGE IN USE .1 a GRADING • a MANUFACTURED HOME
['RELOCATION 0SIGN • 0-TENANT CIOTLIER.
- OWNER / APPLICANT INFORMATION
. _._........j
0 OWNER: -4444/1(.16-1,./11- • 0 APPLICANT:C T.
PHONE: g.74--3 yO FAX: 1Y3 — /o 1, PHONE: FAX
ADDRESS: 6) - ?07Q y ,//, ������. ��
���` GG(f �RESS: •
CITY,STATE,ZIP CITY,STATE,ZIP
°CONTRACTOR: A;744n,----- • ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,.STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR UCENSE# CONTACT:
' PERMIT/BUILDING INFORMATION
or/
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 2-(0 I
BUILDING HEIGHT TO PEAK: • OCCUPANCY GROUP:. 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: YL)L 37" CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
//��
2--NUMBER of BEDROOMS: ' CRITICAL AREAS: GARAGE: ` - 0
FLANKING SETBACK: 'CURRENT PROPERTY SIZE: • COVERED DECK: 7Z4
FRONT SETBACK: CURRENT PROPERTY USE: DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE: p
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: l 2-3 •
MANUFACTURED HOME r SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: - PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
RELOCATION • • FIRE SAFETY I
PREVIOUS ADDRESS: • ' • FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
WA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: _• PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: . . . PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS I
0 BOLTING 0 CONCRETE 0 REINFORCEMENT . ❑ WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S): .
BUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: YES NO IF YES: 0
COUNTY ❑ CITY •
IS PUBLIC WATER AVAILABLE: 0 YES 0 NO IF.YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: 0 YES 0 NO
IS THE PROPERTY LOCATED WITHIN ASA:
0 YES 0' NO PSSA: 0 YES 0 NO
IDATE: I STAFF:
METHOD OF PAYMENT: ,I
0 . ° r _ -, . 0urea •
CASH CHECK
BANKCARD#; EXP/RES: V/NAS
AUTHORIZED SIGNATURE'
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD.
Sori�r 11707 East Sprague Avenue,Suite 106 509-688-0036-Phone
pokane Spokane Valley,WA 99206 509-688-0037-Fax
jValley For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT PERMIT
ADDRESS: USE:
OWNER:Lin nS Lcns T N'lam/ PHONE(Daytime Contact): g'??3)��
MAILING ADDRESS
PU Sol. 30x4 Z Seek vie_ uJ4- gpzz 3
(street) (City/state) (ZIP)
CONTBACTO f S ✓1 re kap LICENSE/:
MAILINGPOAD/GOY; ! 3/ PHONE x:6? 7'I`T 1' e4
Veradab wQ gao -2
(Street) (city/state) (ZIP)
PLUMBING FIXTURES
DESCRIPTION DETAILS I OF UNITS X COST EQUALS AMOUNT
1 TOILETS WATER CLOSET,BIDETS t X $6 -
2 URINALS X $6 -
3 TUBS / X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 -
5 SINKS LAVSBASINS,BAR,FLOOR KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER /� X $6
7 CLOTHES WASHER X $6 -
8 GARBAGE DISPOSAL r X E6 -
9 WATER SOFTENER X 56 -
10 ELECT.HOT WATER TANK NOTE:IF GAS,SEE MECHANICAL X S6 -
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH,CONDENSATE X S6 -
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 S6 -
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
$6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X
17 SPRINKLER SYSTEM X $25 -
18 INTERCEPTORS GREASE TRAP,SAND TRAP,CHEMICAL
HOLDING TANK X
19 MEDICAL GAS per outlet NITROUS,OXYGEN X $6 -
20 MISC.PLUMBING FIXTURE X f6
SUBTOTAL:
METHOD OF PAYMENT
PLUS PROCESSING FEE $35.00
❑ CASH ❑ CHECK 0 NM=
0 :_._. .. .' "
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BAN KCARD NUMBER:
AUTHORIZED SIGNATURE:
I
Sant 11707 East Sprague Avenue, Suite 106 509-688-0036-Phone
o�lialle Spokane Valley;WA 99206 509-688-0037-Fax
4j- Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT ADDRESS: G•liU (� !, / 7 PERMIT
AE:
OWNER yin ocpl,?? ce,z/- /n C PHONE(Daytime Contact): '29 1 y .. w
MAILING ADDRESS:` �YJ
pi/36Y 30 79 z S p ean., 0 4. ci94az 3
(street) (city/state) (ZIP) .
CONTRACTOR: 1/„.1, /l„1.„,A ��u� _ LICENSE I:
MAILING ADDRESS: �( !` ]l PHONE 8:
•
(street) (city/state) (ZIP)
DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOUNT
1 FUEL BURNING APPLIANCE •OR<100,000 / X 515
2 FUEL BURNING APPLIANCE >100,000 X $19 •
3 UNLISTED APPLIANCE(ADDMONAL FEE) •OR<400,000 X $50 •
4 UNLISTED APPLIANCE(ADDmONAL 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 BOILER/REFRIGERATION 1-100M BTU X $15 _ •
8 BOILER/REFRIGERATION 101.500M BTU _ X $28 •
9 BOILER/REFRIGERATION 501.1,030M 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 $10 -
13 RANGE - X $10 •
14 DRYER - X $10 -
15 FUEL BURNING WATER HEATER - / X $10 -
16 MISC FUEL BURNING ADPL. - 'i _ X $10 -
17 GAS PIPING(ea Outlet) - v X $1 •
18 DUCT SYSTEMS - 1 X 510 •
19 VENTILATING FANS - X $10 •
20 AIR HANDLER(DOES NOT include ducting) •OR<I0,000CFM X $12 •
21 AIR HANDLER(DOES NOT tndude ducting) >10,000 CFM X $19 •
22 EVAPORATIVE COOLERS - X 510 -
23 TYPE I HOOD - X 550 -
24 TYPE U HOOD - X 510 -
25 HEAT PUMP/AIR CONDMONER 0-3 TONX 512 -
_
26 AIR CONDITIONER 3-15 TON X $20 •
27 AIR CONDITIONER 15-30 TON X _ $25 -
28 AIR CONDITIONER 30.50 TON X 535 •
29 AIR CONDITIONER *50 TON _ ' X $60 •
30 LPG STORAGE TANK - X $10 •
31 WOOD OR PELLET STOVE/INSERT - X $10 •
32 WOOD STOVE•FREE STANDING - X S25 •
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
111111.1MVISA +L..St
z TOTAL PERMIT FEE DUE:
❑ CASH 0 CHECK ❑ ' ❑ L ..•:--..
DATE: EXPIRES:
BAN KCARD NUMBER
AUTHORIZED SIGNATURE:
` " �t 17.09 From-
T-921 P.14/2T F-445
e ,, CERTIFICATE OF EXEMPTION •
I
�f - , City of Spokane Valley Division of Planning
1 R i'
11707 E Sprague,' 5utte 108
F99205
•
Spokane Vail ,WA.
� f2
Existing "parent"tax parcel numbers} 3507 & 35233.1002' '
"*- ........_,_____E.Site ddress orfroa road name M. 04 - 13th Avenue ,
Public road a Private road ❑ Private driveway Q Auditors recording#:
Legal description - Section ' 23 . Township 2r1 N' . Range l.
That portion of Lloyd Streetvacated •er. •okene Coll Boar o
County Commissioner's Resolutlrofi N. 94-0163 'lying South of 1 th
Avenue and North of the extended centerline of ,,nate$ alley 'within
Blocks 10 and 11, Woodland Tarr-ice as recorded. in Volume II . :. '
. . : .. - ■ .. • • . . . : f - 6 AO WA, /el "aswit on', .. r :n- e East o seat
Total existing acreage pi'.h9n iq.,'� t; New PTvpertyate , , 6,750 eq- ttth$reoi'.
Current zoning VR-3.5 . Comprehensive Plan category Lqw Den • tY
�te�denrtia7
Name of applicant Rocky .Top LW Oil?S Shu1ex, Mone Number it, 1($C 5;999-2610
Mailing address 5813•Sri Avg 'RIZ 202 • •
City,_s, ._. State Washington np..9921R' ' '
•
i certify that I as owner or authorized agent have.exar'tlned this dooument and state that the ation aoritained '
in it and submitted by n16 or my agent to compile said document Id true and correct;and II ' 'MU the City Of
Spokane Valley to proceed with processing. In addition,i have read and understand the.pravisions r• ,;mad herein
and agree to comply with them. l understand that the issuance of this exemption is not Inten ' to.vertfy that
adequate provisions have been made for drainage ways, Potable water supplies,roads and sanitary wastes. Any
subsequent approval based on this exemption shall not be construed to give authority to violate or cancel the
provisions of any state or kcal taw. ,
Applicant �� - ' • . Date 6 6.3
• StairUse Only '
This Certificate of Exemption issued pursuant to section • of the Subdivision
Ordinance for the City of Spokane Valley and RCW 5E07.l7. The Certificate of Exemption is
rn mire.elrt l'e property as described js exempt from the State and Local Subdivision
laws which regulate the sale, lease or transfer of ownership of property and Is subject to the '
following conditions and/or findings:
. 1. NOTICE TO PURCHASER•This piece of property may not have appropriate provlslans for potable water' •
supplies(drinking water),sanitary wastes'{septic tank or sawer)r drains ways,streets ofd,afeys or
other public ways. City of Spokane Valley is not responsible for making provtsione for the a e-stated
hems If 1 propertyis'served by a privets toed,City of Spokane Valley is not poi le lmprbving or
maintaining said private road.. • . • • .
2- l±or property crested via this etemption,the apphcent shall file a Segregation•Appacellon with the County
" . , Assessor prior to ties issuance of a building permit_
, 3- ' This Certificate of Exemption is far and stall sun with the land,and shalt be eppttc+able to the applicant,' owner,h sI1
sirs,successors or assigns. l
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/ /N 'd tSSi 'ON aueIlodS I° XVw/31 &AZ:9 8106 'ZZ 'Ndr
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Proposed Plot Plan
4604 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
A CERTAIN PARCEL OF LAND BEING A PORTION OF LLOYD STREET VACA I'LU PER SPOKANE COUNTY BOARD OF
COUNTY COMMISSIONER'S RESOLUTION NO.94-0163 LYING SOUTH OF 13TH AVENUE AND NORTH OF THE EXTENDED
CEN I LRLINE OF VACATED ALLEY WITHIN BLOCKS 10 AND 11,WOODLAND TERRACE AS RECORDED IN VOLUME II OF
PLATS,PAGE 16,SPOKANE COUNTY AUDITOR'S OFFICE,SPOKANE,WASHINGTON
SCALE 1:20 I SEWER k WA I'EK PROVIDED BY CITY OF SPOKANE
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LOT COVERAGE CALCULATIONS:
LOT SIZE: 7D3.S2
GARAGE: i�30 'LANNlNG DEPT. APPROVED
.(
RESIDENCE: g'(p/
WALKWAY: (,
PATIO: / 72- 3Y. i',€.41
DRIVEWAY: 4.00 T"
BALANCE: s n 5 Z N DATE: 0 l? 4
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