2004, 03-24 Permit App: BLD-04-03882 Residence Smut...411\k% 13UILDING PERMIT APPLICATION WORKSHEET
City of ,okane Valley Community Development Department
po neBuilding Division
T 91707 E. Sprague Avenue, Suite 106
400,
�l �� Spokane Valley, WA 99206
Phone: 50
( 9) 688-0036; Fax: (509) 688-0037
II REQUIRED SI INFORMATION
Street Address: 0 , \ ,B en kite.
Assessor's Tax Parcel Number(s):
Legal Description: LOOc e L W Dock\C nc ---ce xrv-ace.
PERMIT DESCRIPTION: PC__-(A ,
XBuilding Permit ❑ Change in Use ❑ Grading Ti Manufactured Home
Ti Relocation ❑ Tenant Improve: _nt Ti Fire Safety Ti Other
11OWNER/APPLIC NIT INFORMATION
__ 11
_ Owner: L\ra e\I COSkrkKCA-10.0 Ti Applicant:
Phone: 1 Fax: \CA3 Phone: Fax:
Address: .Q Bpi5 )---(0'� Address:
,,,,ane. \ry qq2 -6
C� State Zip Code Cit
_ Y State Zip Code
Contractor: Fame, Ti Architect:
Phone: Fax: . Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILE 3 INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES:
60xWO
MAIN FLOOR TO SQ. FTG: 1 0°-} 2"v FLOOR SQ ` 3: UNPIN BASEMENT SQ. FTG:
FINISHED BASEMENT SQ. FTG: GARAGE SQ. F DECK/COV. PATIO SQ. FTG:
i0 100
OCCUPANCY GROUP: CONSTRUCTIC YPE: HEAT SOURCE:
07l01/4
#OF BEDROOMS:
TOTAL HABIT/ SPACE: IMPERVIOUS SURFACE AREA:
'Z202
COST OF PROJECT: 30% SLOPES is tOPERTY: SEWER OR ON—SITE SEPTIC
SYSTEM? The. Q r
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
❑ BOLTING [ CONCRETE n REINFORCEMENT n 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:
Yj/vs 01/11\tillik MECHANICAL PERMIT APPLICATION
(1 'tang City of Spokane Valley Community Development Department
��IIVV1111�A11vy BuildingDivision
..,,,,Valley 11707 E. Sprague Avenue, Suite 106
G Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: L.K0\7j .. \'fie Awe`(\u...e._, Permit Use:
Owner: 1_\ +• Phone (Daytime Contact): 5 • 10
Mailing Address: Q .% . bn 0 L.. v )L,ne
City State Zip Code
Contractor: License#: Phone#:
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 FUEL BURNING APPLIANCE Equal to or less than 100,000 ! X $15.00 =
2 FUEL BURNING APPLIANCE More than 100,000 X $19.00 =
3 UNLISTED APPLIANCE(Additional Fee) Equal to or less than 400,000 X $50.00 =_
4 UNLISTED APPLIANCE(Additional Fee) More than 400,000 X $100.00 =
USED APPLIANCE(V1lSEC min.AFUE
5 rating) Equal to or less than 400,000 X $50.00 =
USED APPLIANCE(WSEC min AFUE
6 rating) More than 400,000 X $100.00 =
7 BOILER/REFRIGERATION 1-100M BTU X $15.00 =
8 BOILER/REFRIGERATION 101-500M BTU X $28.00 =
9 BOILER/REFRIGERATION 501-1,000M BTU X $39.00 =
10 BOILER/REFRIGERATION 1,001-1,750M BTU X $57.00 =
11 BOILER/REFRIGERATION More than 1,750M BTU X $95.00 =
12 GAS LOG,GAS INSERT,GAS FIREPLACE X $10.00 =
"
13 RANGE X $10.00 =
14 DRYER X $10.00 =
15 FUEL BURNING WATER HEATER t X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) t 2.. X $1.00 =
18 DUCT SYSTEMS X , $10.00 =
19 VENTILATING FANS b X $10.00 =
20 .AIR HANDLER(DOES NOT include ducting) Equal to or less than 10,000 CFM X $12.00 =_
21 AIR HANDLER(DOES NOT include ducting) Greater than 10,000 CFM X $19.00 =
22 EVAPORATIVE COOLERS X $10.00 =
23 TYPE I HOOD X $50.00 =
24 TYPE II HOOD X $10.00 =
25 HEAT PUMP/AIR CONDITIONER 0-3 TON X $12.00 =
26 AIR CONDITIONER 3-15 TON X $20.00 =
27 AIR CONDITIONER 15-30 TON X $25.00 =
28 AIR CONDITIONER 30-50 TON X $35.00 =
29 AIR CONDITIONER More than 50 TON X $60.00 =
30 LPG STORAGE TANK X $10.00 =
31 WOOD OR PELLET STOVE/INSERT X $10.00 =
32 WOOD STOVE-FREE STANDING X $25.00 =
METHOD OF PAYMENT: SUBTOTAL
Q CASH 0 CHECK 0 VISA I]MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
PLUMBING PERMIT APPLICATION
11'try 4011"_ � ,City of Spokane Valley Community Development Department
j�'j�"` BuildingDivision
le 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
40010Val
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: 1---\-0 1 E • \o\-- ' p\I-e-ru-e, Permit Use:
Owner: �a,nC\ e.,\I C.1Y\ _5 -UG Dr--) Phone (Daytime Contact): 0 \O\�
Mailing Address: e• D, X07._ ?-5O71i'L. T"Y-1x t'r- VVIA- qg
City State Zip Code
Contractor: ‘.._\\n , C,c,15k�(LICh x icense#: Phone#: 5(Q5< 1O\-
Mailin Address: 7 0, X01 q`Z a�o-' - v A o��-
Mailing " City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS WATER CLOSET,BIDETS '2- X $6,00 =
2 URINALS X $6.00 =
3 TUBS 2. X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT -X $6.00 =
5 SINKS LAVSIBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, 3 X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER ` X $6.00 =
7 CLOTHES WASHER I X $6.00 =
8 GARBAGE DISPOSAL I X $6.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $6.00 =
11 FLOOR DRAINS AREA,CASE,COIL,TRENCH, X $6.00 =
CONDENSATE _
12 ROOF DRAINS/OVERFLOW DRAINSX $6.00 =
13 FOUNTAINS,DRINKING X $6.00 =
14 WATER PIPING/DRAIN-IN WASTE, INSTALLATION,ALTERATION, X $6.00 =
VENT, PLUMBING,REVERSAL REPAIR,REVERSALS
15 SEWAGE EJECTOR GRINDER,SUMP PUMP X $6.00 _=
16 WATER USING DEVICE ICE AN/OR COFFEE MAKER,
HOSE BIB,STEAMER,PROOFER, 3 X $6.00 =
CARBONATOR,SWAMP COOLER
17 CROSS CONNECTION DEVICE VACUUM BREAKER,CHECK
VALVE,AND R.P.B.P.D.FOR: X $6.00 =
VATS,TANKS,BOILERS
18 INTERCEPTORS GREASE TRAP,SAND TRAP, X $6.00 =
CHEMICAL HOLDING TANK
19 MEDICAL GAS(per outlet) NITROUS,OXYGEN X $6.00 =
20 MISCELLANEOUS PLUMBING FIXTURE X ` $6.00 =
METHOD OF PAYMENT: SUBTOTAL
0 CASH 0 CHECK 0 VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
00.°°\ftrik Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
Spokane
,,,II•�Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-166 Account#
ROW CONSTRUCTION PERMIT
Location of property 4613 E. 13th Ave.
(Address/Parcel#, if available)
Applicant Name Lindsey Construction Fax
Address P.O. Box 30792 Spokane,Wa. 99223 Phone 509-879-3420
Contractor's Name
Address Phone
Contractor's Reg.# LINDSCI066OW Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
ElSewer Connection ■ Driveway
Curb &Gutter 111 Gas Installation/Repair
❑ Cable/Conduit/Pole Sidewalk Repair/Construction
❑ Water Installation/Repair n Other
❑ Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved Date .3-
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Si.nature
Fees Paid$ 25.00 25.00 Date Init
(Application) (Inspection)
In addition to the permit application fee of$16.00(utility)or$25.00(construction), inspection on
each permit will be billed to the permittee at a rate of$50.00 per hour with a$25.00(1/2 hour)
minimum. Permittee signature constitutes an agreement to these terms and provisions.
Work completed satisfactorily(Signed) Date
Permit not valid until One-Call Notification Ticket#entered here
PERMIT MUST BE KEPT ON SITE
Proppsed Plot Plan
4613 Fast 13th Avenue
City f Spokane Valley
County of Spokane,State of Washington
LOT 9,BLOCK 4,WOODLAND TERRACE
SCALE 1:20 t SEWER&WA 1"ER PROVIDED BY CITY OF SPOKANE
ti9, 90
Tills site plan Is being submitted for the purpose of
obtaining a building permit and is a true and correct
representation of the proposal. Alt known property
tines/dimensions,curb tines,structures and easements
have been Identified. Also Indicated are wetlands,
bodies of w r, steep slopes or other critical areas.
Signed:
Dela: Z7/41L./.e:1-
3-2f
O F
N
ADDRSS (e/3 E 3
/ ZONE
�1< 3 D 7 ROAD WIDTH ,e 0
FRONTE ..2 F K1N(,—
COMMENT ,
REVIEWED ►.��'% 7!�►%r�
20
N 7 �
V
4°r go
LINDSEY CONSTRUCTION,INC.
PO BOX 30792
SPOKANE,WASHINGTON