2004, 05-10 Permit App: BLD-04-04315 Residence BUILDING PERMIT APPLICATION WORKSHEET
CITY miteCity of Spokane Valley Community Development Department
Building Division
l.le 11707 E. Sprague Avenue, Suite 106
4000Va
Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax: (509) 688-0037
REQUIRED SITE INFORMATION
Street Address: /-/7/d e /3
Assessor's Tax Parcel Number(s):
Legal Description: '' Iz0/J1���2�•t
PERMIT DESCRIPTION:
"Building Permit E Change in Use fl Grading ❑ Manufactured Home
E Relocation ❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
Owner: i )w,6/ 6,,,,„z_ ❑ Applicant:
Phoneme({-111 13 Fax: qki 3— 11,13 Phone: Fax:
Address: MIL, 3,9792 Address:
City "' Ol aja 9 to p Code City State Zip Code
❑ Contractor: 4/40.4._— ❑ Architect:
Phone: Fax: Phone: Fax:
Address: Address:
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK: DIMENSIONS: #OF STORIES: t
MAIN FLOOR TO SQ. FTG: 2"" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:15-7
67C1 11§1F
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: 442.7___ DECK/COV. PATIO SQ. FTG:
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: 2115
#OF BEDROOMS: TOTAL HABITABLE SPACE: , IMPERVIOUS SURFACE AREA:
��/ / /09
COST OF PROJECT: 30% SLOPS ON PROPERTY: SEW ON-SITE SEPTIC
&5 EM?
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
H 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:
r
4
' ~ MECHANICAL PERMIT APPLICATION
City City of Spokane Valley Community Development Department
4)okaneBuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
�/ FOR INSPECTIONS, CALL(509) 688-0054
Project Address: "1 7 P 6- /9 Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
Pea_ etitiCity State Zip Code
Contractor: ).-{�Qlt (4,q 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 1 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(WSEC 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 r X $10.00 =
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 2 X $1.00 =
/
18 DUCT SYSTEMS ( X $10.00 =
19 VENTILATING FANS L 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
❑CASH ❑CHECK ❑VISA 0 MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
ti
y
PLUMBING PERMIT APPLICATION
SCITy� kine City of Spokane Valley Community Development Department
lr�U�j/!�'�)�j�jq C BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
400Spokane Valley, WA 99206
Phone: (509) 688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509) 688-0054
Project Address: 71 D /3 Permit Use:
Owner: Phone (Daytime Contact):
Mailing Address:
City State Zip Code
.ry p
Contractor: �l�D C. iuVL4 igl VAel License#: Phone #:
Mailing Address:
City State Zip Code
#OF TOTAL
DESCRIPTION OF WORK UNITS X COST = AMOUNT
1 TOILETS WATER CLOSET,BIDETS - X $6.00 =
2 URINALS n X $6.00 =
3 TUBS 2 X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 =
5 SINKS LAYS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER I X $6.00 =
7 CLOTHES WASHER I X $6.00 =
8 GARBAGE DISPOSAL ' 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 DRAINS X $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, 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
❑ CASH ❑ CHECK 0 VISA 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
Call 24 hours before inspection required
CITY
' ane
p Phone 509.688-0195 Fax 509.688-0037
Valley DEPARTMENT OF PUBLIC WORKS
Anticipated start date Permit# 04-334 Account#
ROW CONSTRUCTION PERMIT
Location of property 4710 E. 13th Ave.
(Address/Parcel#, if available)
Applicant Name Lindsey Construction Fax
Address P.O. Box 30792 Spokane,Wa. 99223 Phone 509-879-3420
Contractor's Name
Address Phone
Contractor's Reg.# LINDSCI066OW Expires
PROJECT DESCRIPTION (Provide site sketch or plan as necessary for clarity)
Sewer Connection ■ Driveway
El Curb &Gutter ❑ Gas Installation/Repair
111 Cable/Conduit/Pole Sidewalk Repair/Construction
Water Installation/Repair El Other
❑ Pavement Cut Dimensions
Bond/insurance certification must be on file with the City. Bond#
SPECIAL CONDITIONS: Construct driveway approach per Spokane County Standards as
adopted by the City of Spokane Valley.
See attached Provisions
Permittee Signature Approved Date J`
I hereby authorize the City of Spokane Valley to charge the fee for this permit to my credit card.
Card# Expiration Date
Name of Holder Si.nature
Fees Paid$ 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
,"
Proposed Plot Plan
4710 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
LOT 4, BLOCK 12, WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE
N ADDRESS: IA1l
/I U E 13�
I ZONE:UR 3.5
ROAD WI,TH:.60
FRONT: bS 1 FLANKI
COMMENTS.�
REVIEWED ;RIMEL. '
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The sitc plan is
eing subitteor the purpose of I--
I/ r : I i l I Obtaining a bu`Idn S perm tmand s Fa true and correct
/"N\
VI Representation r the proposal. All known Property
LL/:(l kI -[ines/dimensions,icurb lines,structures and easements
{� -kI have keen identified. Also indicted arc wetlands,
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I 15odics or water,steep slopes or other critical areas.
I ^/ I I i Lindsey Construction,Inc.
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