2004, 06-24 Permit App: BLD-04-04710 Residence *Kane
BUILDING PERMIT APPLICATION WORKSHEET
City of Spokane Valley Community Development Department
Building Division
�/
T � 11707 E. Sprague Avenue, Suite 106
4000* lev Spokane Valley, WA 99206
Phone: (509) 688-0036; Fax:
(509) 688-0037
REQUIRED SITE INFORMATION
Street Address: Li )13 I 13 )14-1
Assessor's Tax Parcel Number(s):
Legal Description: /PR Id ) 1 al 3 /0' .1)//w.,,;( 7.�/'Ae
PERMIT DESCRIPTION: (I
[]"Building Permit ❑ Change in Use ❑ Grading D Manufactured Home
❑ Relocation
❑ Tenant Improvement ❑ Fire Safety ❑ Other
OWNER/APPLICANT INFORMATION
ElOwner: .tN®SEY CONSTRUCTION, INC. U!DSEY CONSTRUCTION, 6•r _
P.O. BOX 3O/Yz ❑ Applicant: ,,,o. six 1n742
Phone: ''')KANE, WA 99 ; Phone: �"'ANE, WA 99FX:
Address: Address:
City State Zip Code City State Zip Code
❑ Contractor: ❑ Architect:
Phone:
'I.II DSEY CONSTIEt oK INC_ Phone: Fax:
Address: O BOX 30792 Address:
--"'CANt, WA 99223
City State Zip Code City State Zip Code
WA State Contractor License #: Contact:
PERMIT/BUILDING INFORMATION
HEIGHT TO PEAK DIMENSIONS: 3 6 *c,/- #OF STORIES: /
MAIN FLOOR TO SQ. FTG:/ 2" FLOOR SQ. FTG: UNFIN BASEMENT SQ. FTG:
CZ 1' /0ep0
FINISHED BASEMENT SQ. FTG: GARAGE SQ. FTG: qs DECK/COV. PATIO SQ. FTG:
/ 3/
OCCUPANCY GROUP: CONSTRUCTION TYPE: HEAT SOURCE: ,,
#OF BEDROOMS: TOTAL HABITABLE SPACE: IMPERVIOUS SU FACE AREA:
;,2, I�'L� vU fe
COST OF PROJECT: 30%SLOPES ON PROPERTY: SEWEB.OR ON-SITE SEPTIC
M? yes
s
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
D BOLTING ❑ CONCRETE El 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:
4 ►
•
� PLUMBING PERMIT APPLICATION
S " e City of Spokane Valley Community Development Department
Valley
Buil�ngDivision
4 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: 4 7/ 3 G / Permit Use:
Owner: t zA_ek ( - - Phone (Daytime Contact):
Mailing Address: 7 9Z %/.0,e —
City State Zip Code
Contractor if fii& br , License#: Phone#:
Mailing Address:
City State Zip Code
OF TOTAL
DESCRIPTION OF WORK UNITS X COST - AMOUNT
1 TOILETS WATER CLOSET,BIDETS 3 X $6.00 =
2 URINALS X 58.00 -
3 TUBS 3 X $8.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT X $6.00 _=
5 SINKS LAVS/BASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHER ' X $6.00 =
7 CLOTHES WASHER / X 58.00 =
8 GARBAGE DISPOSAL I X 58.00 =
9 WATER SOFTENER X $6.00 =
10 ELECTRIC HOT WATER TANK NOTE: IF GAS,SEE MECHANICAL X $8.00 =
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, '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 $8.00 =
METHOD OF PAYMENT: SUBTOTAL
❑ CASH 0 CHECK 0 VISA ❑ MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
A
StkialalleCity of Spokane MECHANICAL PERMIT APPLICATION
,\NValley Community Development Department
' ' BuildingDivision
ley 1 1707 E. Sprague Avenue, Suite 106
4,,Val
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
FOR INSPECTIONS, CALL(509)688-0054
Project Address: 7t Permit Use:
Owner: Phone(Daytime Contact):
Mailing Address: `1 fy -30 Z 7,2L/f� /�''Z-'
���� �� City State Zip Code
Contractor. 2 .-4 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 I X $15.00 =
2 FUEL BURNING APPLIANCE Marathon 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 / X $10.00
16 MISC.FUEL BURNING APPLIANCE X $10.00 =
17 GAS PIPING(each outlet) 3 X $1.00 =
18 DUCT SYSTEMS / X $10.00 =
19 VENTILATING FANS J 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 j 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
0 CASH ❑CHECK Q VISA Q MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Proposed Plot Plan
4713 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
A PORTION OF LOTS 10&11, BLOCK 3, WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE N
ADDRESS: —E_-L 3
ZONE:UR 3.5
ROAD WIDTH:60
— 5 53, 19 -L, FRONT:D--5 FLA. ING______
I COMMENTS: __
REVIEWED BY:Wh � 0 ' -^l_
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i The site plan is being submitted for the purpose of
/j l I - Obtaining a building permit and is a true and correct
� Representation of the proposal. All known property
s i
Lines/dimensions,curb lines,structures and easements
R I identified. Also indicted are wetlands,
UTi�- �Ty ,� y ti have been
G-501 T. --./ /l yN iZ to bodies of water,steep slopes or other critical areas.
Lindsey Construction, Inc.
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