2004, 03-01 Permit App: BLD-04-03649 Residence ,
4.00Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
19 707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: ' IC? C / J
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION: k "Z. 8IA kint jar?d' Te/6721(i
PERMIT DESCRIPTION: g,
UILDING.PERMIT CI GRANGE IN USE a.GRADING D MANUFACTURED HOME
aRELOCATION D-SIGN E TENANT 0 OTHER
•
OWNER / APPLICANT INFORMATION
a OWNER: 1I il'Oce r r[ a APPLICANT:
PHONE: `57GG',{ QIDI 3 FAX: --)e)/3 PHONE: FAX:
U
ADDRESS:! !.'d)( 7_lp 96. l Ci'C/&3 ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
®
CONTRACTOR:_____424.2 'Z 2-'" ® ARCHITECT:
PHONE: FAX: PHONE: FAX:
ADDRESS: ADDRESS:
CITY,STATE,ZIP CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
PERMIT/BUILDING INFORMATION
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: 9 /
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS: 52x.3--g( CONSTRUCTION TYPE: UNFIN BASEMENT: S'1U
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 2 CRITICAL AREAS: GARAGE:
FLANKING SETBACK: 1 C CURRENT:PROPERTY SIZE: COVERED DECK:
FRONT SETBACK: �'S CURRENT PROPERTY USE: DECK: MZ)
REAR SETBACK: 4'h '1i1 CURRENT SEPTIC USE:
LEFT SETBACK: : " I CURRENT WELL USE:
RIGHT SETBACK: IMPERVIOUS SURFACE AREA: NC
i
MANUFACTURED HOME SIGN
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
1 RELOCATION FIRE SAFETY 11
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
IWA STATE NON-RESIDENTIAL ENERGY CODE
PLANS EXAMINER: PHONE: FAX:
ADDRESS:.
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
I SPECIAL INSPECTIONS
0 BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
1 BUILDING STAFF USE ONLY_
0
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: ® YES 0 NO
IDATE: I STAFF:
METHOD OF PAYMENT:
® ® ® r - 0 unommi
V
ISA
CASH CHECK momma
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE:
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
(�(ITY'OF• w%,, 11707 East Sprague AvenSuite 106 509-688-0036-Phone
/Jpo�rie Spokane Valley,WA 99206 509-688-0037-Fax
400*Valley For Inspections, call 509-688-0054
Mechanical Permit Application
PROJECT PERMIT
ADDRESS: 1716 ;q 13 USE:
OWNER:
i
'114/Zetiliali PHONE(Daytime Contact):
MAILING ADDRESS:
(street) (city/state) (ZIP)
CONTRACTOR: /rim/4_ /�1 ,�,1 ✓ di„:%,..j.,? LICENSE It:
MAILING ADDRESS: �j 1� / PHONE It:
• (street) (city/state) (ZIP)
DESCRIPTION OF WORK #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<400,000 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 BOILER/REFRIGERATION 1-100M BTU X $15 =
8 BOILER/REFRIGERATION 101-500M BTU X $28 =
9 BOILER/REFRIGERATION 501-1,000M 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 APPL. -
V."--. X $10 =
17 GAS PIPING(ea.Outlet) - / X $1 -
18 DUCT SYSTEMS - X $10 =
19 VENTILATING FANS - "3 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 $50 =
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 $25 =
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 WOOD STOVE-FREE STANDING - X $25 =
SUBTOTAL:
METHOD OF PAYMENT PLUS PROCESSING FEE: $35.00
MUM l ' TOTAL PERMIT FEE DUE:
VISA' r'u'--I-_s
0 CASH 0 CHECK ❑ =NM 0 ;_ .
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
S. CITV OFj,,�., rr 11707 East Spralte Av'entie,Suite 106 509-688-0036-Phone
.1kane Spokane Valley,WA 99206 509-688-0037-Fax
4000VdlleY For Inspections, call 509-688-0054
Plumbing Permit Application
PROJECT nn PERMIT
ADDRESS:p/ ? ,, /1 - USE:
OWNER: [ C�1 - ��i`. PHONE(Daytime Contact):
S:1
MAILING ADDR SS:
,64...4 '-7
'l/2 2q Z
(street) �(city/state) (ZIP)
CONTRACTOR: ,/i 7.9 ,�j0,7e�,,`. ( PHONE#LICENSE#:
MAILING ADDRESS:
(street) (city/state) (ZIP) '
PLUMBING FIXTURES
DESCRIPTION DETAILS #OF UNITS X COST EQUALS AMOUNT
1 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 LAVSBASINS,BAR,FLOOR,KITCHEN,
LAUNDRY,UTILITY,JANITOR,PHOTO,X- F X $6 =
RAY,FOOD,PREP/CULINARY/MEAT
6 DISHWASHER X $6 -
7 CLOTHES WASHER ` 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,COIL,TRENCH,CONDENSATE I. 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
R.P.B.P.D.FOR:VATS,TANKS,BOILERS X $6 -
17 SPRINKLER SYSTEM 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
f
• yam- rlfan.
PLUS PROCESSING FEE: $35.00
0 CASH 0 CHECK ❑ ❑ L._._ :.__ .
-
TOTAL PERMIT FEE DUE:
DATE: EXPIRES:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
f . -"1
Call 24 hours before inspection required
Phone 509.688-0195 Fax 509.688-0037
Sivol(ane
40000Val ley
DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-091 Account#
ROW CONSTRUCTION PERMIT
Location of property 4619 E. 13th Ave.
(Address/Parcel#,if available)
Applicant Name Lindsey Construction Co. Fax
Address P.O. Box 30792, Spokane,Wa. 99223 Phone 509-879-3420
Contractor's Name
Address Phone
Contractor's Reg.# LINDSCI066OW Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
7 Sewer Connection ■ Driveway
nCurb & Gutter n Gas Installation/Repair
n Cable/Conduit/Pole n Sidewalk Repair/Construction
n Water Installation/Repair n Other
nPavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS:
See attached Provisions
Permittee Signature Approved z---r.L. �----._, Date - �f
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Signature
Fees Paid$ 25.00 25.00 Date !nit
(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
Y DEPARTMENT OF COMMUNITY DEVELOPMENT CIT
pokane
CURRENT PLANNING
ADMINISTRATIVE EXCEPTION
40,0"alley
APPLICATION AND DETERMINATION
PART I
APPLICANT: LIM tSeV �`,OncS-\-r'U.C-h�1
MAILING ADDRESS: 1 OX 7@
CITY: JD CIANO STATE:
v� V �c ZIP: 20_2,22t
C
PHONE: (HOME) (WORK) C� 7g3�G0 (CELL)
NOTE:IF APPLICANT IS NOTTHEOWNER,INCLUDE WRITTEN OWNER AUTHORIZATION FROM THE LEGAL OWNER BELOW
LEGAL OWNER: U�f1C1 y C®tk4r -tAc �1
MAILING ADDRESS: ? o > box_ 307G1 2
CITY: Zpn1(f)_;� ��STAT �`'�E: \N ZIP:` 7-�
PHONE: (HOME) (WORK) 3(Q 101 (CELL)
TAX PARCEL No: 3'5,9330401
_ STREET ADDRESS OF SITE:
LEGAL DESCRIPTION: j,UnC2(V C A t---C I i K. 4
SECTION(S) f> TOWNSHIP 4 RANGE C
ZONING CLASSIFICATION: .< 3
COMPREHENSIVE PLAN CATEGORY: L-6 \R--
TYPEOF ADMINISTRATIVE EXCEPTION REQUESTED: H a r E\i--eL Ara Ie1C
EXPLAIN REASON FOR REQUEST: Srno.t k l& , SPS} koc c..Y-N_ w\cj &Q,
\nct rA *o ff 1c‘
APPLICABLE SECTIONS)OF ZONING CODE: I 4•.'SO ,5s( b) I `t• . t 6 p ,3 64)Cf.)
NOTE: A SITE PLAN AND SUPPORTIVE DOCUMENTS SHALL BE INCLUDED WITH THIS APPLICATION
.
PART IV
•
DETERMINATION
File No: AR-1:7-63- 0
The Department of Community Development finds that the information provided by the applicant and required
compliance with the City of Spokane Valley Zoning Code and all other development regulations, does / does not
adverse affect on the adjacent properties nor the. ' general health, safety and welfare.
The Department of Community Develop ent ap r denies this "Administrative Exemption" as conditioned
below, for the property described in Part I,pursuant to Sections 14.506.000 and 14.506.020 of the Zoning Code.
This administrative exception is subject to the following conditions of approval:
1) This administrative decision shall apply to the subject property indefinitely and may be transferred to future
property owners, heirs or any successor in interest to the property subject to the conditions of approval
contained herein.
2) The applicant and property owner shall comply with all requirements and regulations of the Zoning Code.
3) The applicant shall comply with all applicable development regulations and standards.
4) The applicant and property owner shall comply with the following additional conditions:
This administrative exception hereb ap.roved this day of F I''1- -;, L, , 20t
1/4
Approved b, • _ _. . I' . = Title: ,LA,vw.L-4...67 11
Under Section 14.412.041 of the City Zoning Code, any person aggrieved by this administrative determination has
the right to appeal this administrative decision to the City of Spokane Valley Hearing Examiner. An appeal must
be filed by submitting the appropriate appeal application together with the required fee to the Department, of
Community Development Current Planning, within fourteen(14) calendar days after the decision is issued. Upon
receipt of a complete appeal application, a public hearing will be scheduled.
For information or questions,please call(509) 921-1000 Rev 6/03
Jv i 3 3 . . .-
Proposed Plot Plan
4619 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
LOT 12, BLOCK 4, WOODLAND TERRACE
SCALE 1:20 1 SEWER di WATER PROVIDED BY CITY OF SPOKANE NI
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DATE: