2003, 12-11 Permit App: BLD-03-03243 Residence si), an. ial \i„„„ ,
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PERMIT APPLICATION ORK SHEET
SPOKANE VALLEY COMMUN/TYDEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
--- Phone: 509 688-0036 Fax: 509)688-0037
------------ --------- -----------------------------
REQUIRED SITE INFORMATION -- -- - - - _
STREET ADDRESS: '' � 3
ASSESSOR'S TAX PARCEL NUMBER(S): /
LEGAL DISCRIPTION: .&.1-9,-/ /911( 11
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PERMIT
camPERMIT DESCRIPTION: 5F11---
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_ OWNER / APPLICANT INFORMATION -1
' 4.0X 30792
O OWNER:4PCIONE, WA 99223 0 „J' ii CONSTRUCTION,
7 , / ,r1 APPLICANT: Ih�.
PHONE: A ----? FAX: LF Y 3 /y 13
PHONE: SP !;ANE, WA 992�,q
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ADDRESS: !`A :
014.1CITY,STATE,ZIP ADDRESS:
CONTRACTOR: BGIX �roNSTRUCTION, IR 0.. CITY,STATE,ZIP
PHONE: ', 'ANF, 1 A 99221 ARCHITECT.:
f�AX:
ADDRESS: PHONE: FAX:
CITY,STATE,ZIP ADDRESS:
WA ST CONTRACTOR LICENSE# 2�.�242//� /' CITY,STATE,ZIP
CONTACT:_1-PI^
L______
PERMIT/BUILDING INFORMATION -
COST OF PROJECT: -1
30%SLOPES ON PROPERTY:________ ��
MAIN FLOOR SQ FT: 2-
BUILDING HEIGHT TO PEAK:
OCCUPANCY GROUP:
BUILDING DIMENSIONS: 2N0 FLOOR SQ FT:__
CONSTRUCTION TYPE: UNFIN BASEMENT: 11.4_
NUMBER OF STORIES: I STRUCTURES ON PROPERTY:
NUMBER of BEDROOMS:2-' FINISHED BASEMENT:
CRITICAL AREAS: /7 O
FLANKING SETBACK: GARAGE:
CURRENT PROPERTY SIZE: �.
Lj � -' COVERED DECK:
FRONT SETBACK:
CURRENT PROPERTY USE:
DECK:
REAR SETBACK: CURRENT SEPTIC USE:
LEFT SETBACK: CURRENT WELL USE:
RIGHT SETBACK: /b` qD IMPERVIOUS SURFACE AREA: •
SaT1't > 1170,7 East Sprague
Avenue, Suite 106 509-688-0036-Phone
Pe Spokane Valley, WA 99206 509-688-0037-Fax
41.jValley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 1167 '- G /3 USE:
OWNER n 0541 cast `n C- PHONE(Daytime Contact): 8'29 '! y ? ,.
MAILING ADDRESS: `'r/ �—YJ
P1,nx 30712 Spoani (LIQ 99?& 3
(street) (city/state) (ZIP)
CONTRACTOR:j�,,,_ 1 ir LICENSE I:
MAILING ADDRESS:/ 7 PHONE I:
(street) (city/state) (ZIP)
DESCRIPTION OF WORK I OF UNITS X COST EQUALS AMOLWT
I FUEL BURNING APPLIANCE •OR<100,000 r _ X 515 •
2 FUEL BURNING APPLIANCE >100,000 X 519 •
3 UNLISTED APPLIANCE(ADDITIONAL FEE) •OR<400,000 X 550 •
4 UNLISTED APPLIANCE(ADDITIONAL FEE) >400,000 X 5100 •
5 USED APPLIANCE(WSEC min.AFUE rating) •Or<400,000
X $50 •
6 USED APPLIANCE(WSEC min.AFUE rating) >400,000 X 5100 •
7 BOILER/REFRIGERATION 1•100M BTU X 515 •
8 BOILER/REFRIGERATION , 101•500M BTU X $28 •
9 BOILER/REFRIGERATION 501•1,030M BTU X 539 -
10 BOILER/REFRIGERATION 1001-1,750M BTU X 557 •
11 BOIL ER/REFRIGERATION •1750M BTU X 595 •
12 GAS LOC,GAS INSERT,GAS FIREPLACE - X 510 •
13 RANCE - X 510 •
14 DRYER - X $10 •
15 FUEL BURNING WATER HEATER - I X 510
•
16 MISC FUEL BURNING APPL. - X 510 -
17 CAS PIPING(ea.Outlet) - X Si •
18 DUCT SYSTEMS -
/. X $10
•
19 VENTILATING FANS - X S10 •
20 AIR HANDLER(DOES NOT include ducting) •OR<10,000CFM X 512 -
21 AIR HANDLER(DOES NOT Include ducting) >10,000 CFM X $19 •
22 EVAPORATIVE COOLERS - X 510 •
13 TYPE I HOOD - X $50 •
24 TYPE II HOOD - X 510 •
25 HEAT PUMP/AIR CONDITIONER 0.3 TON r' X $12
26 AIR CONDITIONER 3-15 TON ll X 520 •
27 AIR CONDITIONER 15.30 TON X 325 •
28 AIRCONDMONER 30.50 TON X 535 •
29 AIRCONDI.1-IONER +50 TON X S60 •
30 LPG STORAGE TANK - X 510 •
31 WOOD OR PELLET STOVE/INSERT - X 510 •
32 WOOD STOVE•FREE STANDING - X 525 •
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
ItSl?Sf= •• TOTAL PERMIT FEE DUE:
❑ CASH 0 CHECK 0 EMI= ❑ L.._ ' _.
DATE: EXPIRES:
BAN KCARD NUMBER:
AUTHORJZF:D SIGNATURE:
ld°
SCITv(Y 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: li6/ z e j 3 USE:
OWNER:14n
wn S T ,'/ PHONE(Daytime Contact): s' ��
MAILING ADDRESS: ��/
p a 130.1. 34^2q Z S poone_ 1, 99zz 3
(street) (city/state) (ZIP)
CONTIi 4CTv 7 S igr41ALIrs LICENSE 0:
MAILING ADDRESS: PHONE#:
po leo- ci 3 I 907-
Ve a eta6 lva ci4D?7
(street) (city/state) (ZIP) •
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
I TOILETS WATER CLOSET,BIDETS X $6 -
2 URINALS X $6 -
3 TUBS
X $6 -
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6 -
5 SINKS LA VS/BASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- X $6 -
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER
t.
/ X $6
7 CLOTHES WASHER / X $6 -
8 GARBAGE DISPOSAL f 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 / 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 $6 -
R.P.B.P.D.FOR:VATS,TANKS,BOILERS
17 SPRINKLER SYS I EM 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:
METHOD OF PAYMENT
VISA !fits PLUS PROCESSING FEE: $35.00
❑ C.=.SH ❑ CHECK E IMESSIN ❑ l_._.__.. :
TOTAL PERMIT FEE DUE:
D.4.TE EXPIRES:
BANKCA.R.D NUMBER.
.`.'CT?-iORJZED SIGNATURE:
Proposed Plot Plan
4612 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
LOT 4, BLOCK 11, WOODLAND TERRACE
SCALE 1:20 I SEWER do WATER PROVIDED BY CITY OF SPOKANE
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PLANNING DEPT. APPROVED -
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DATE: 17 11110;
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Proposed Plot Plan
4612 East 13th Avenue
City of Spokane Valley
County of Spokane, State of Washington
LOT 4, BLOCK 11, WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE
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