2004, 10-04 Permit App: BLD-04-07929 Residence }
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PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone:(509)688-0036 Fax:(509)688-0037
I REQUIRED SITE INFORMATION
_ I
STREET ADDRESS: 1-1-1 i f CX * ' i%�f Ae__i
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION:
BUILDING PERMIT CHANGE IN USE a GRADING MANUFACTURED HOME
Q LOCATION ®SIGN ®TENANT OTHER
I OWNER / APPLICANT INFORMATION
1
XOWNER: L\i11 CD t -Inc- 0 APPLICANT:
PHONE: 10/ FAX: 3 101 3T - ,NE: FAX:
ADDRESS:Po 0u c a1G Z c •�KG`fl€ A .
CITY}� AT ZIP I V (' CITY,STATE,ZIP
/1RCONTRACTOR:
ae V V �'aj�2 •
• •CHITT,
PHONE: FAX: ii• ONE: 1 FAX:
ADDRESS: D E#Sk] Q Q al G
CITY,STATE,ZIP 6 CITY,STATE,ZIP
WA ST CONTRACTOR LICENSE# CONTACT:
I PERMIT/BUILDING INFORMATION
1
COST OF PROJECT: 30%SLOPES ON PROPERTY: MAIN FLOOR SQ FT: I `3'7_.._
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2ND FLOOR SQ FT:
BUILDING DIMENSIONS:*X V( CONSTRUCTION TYPE: UNFIN BASEMENT: lit 0
NUMBER OF STORIES: I STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: 2 CRITICAL AREAS: GARAGE: -7 1
FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK: 4 291
FRONT SETBACK: 2-3-
CURRENT PROPERTY USE: DECK: \or) 'I" )j lU
REAR SETBACK: 4671 CURRENT SEPTIC USE:
LEFT SETBACK: 7 CZ CURRENT WELL USE:
RIGHT SETBACK: 1 Qi IMPERVIOUS SURFACE AREA: 1(71L-f5
1
IMANUFACTURED HOME SIGN 1
WIDTH: LENGTH: SQ FT OF SIGN: HEIGHT OF SIGN:
YEAR: PIT SET: #OF SIGNS: AREA OF EXIST SIGN:
MANUFACTURER: TYPE OF SIGN:
I RELOCATION FIRE SAFETY
PREVIOUS ADDRESS: FIRE SPRINKLER: FIRE ALARM:
PAINT BOOTH: TENT:
PROPOSED USE: FIREWORKS DISPLAY:
BLASTING: DATE/TIME:
• 1 WA STATE NON—RESIDENTIAL ENERGY CODE I
PLANS EXAMINER: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
INSPECTOR: PHONE: FAX:
ADDRESS:
CITY,STATE,ZIP
SPECIAL INSPECTIONS
® BOLTING ®CONCRETE ® REINFORCEMENT ® WELDING
FIRM NAME: PHONE: FAX:
INSPECTOR(S):
IBUILDING STAFF USE ONLY
IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: ® COUNTY ® CITY
IS PUBLIC WATER AVAILABLE: a YES a NO IF YES,WHICH WATER DIST/IRR:
IS PROPERTY LOCATED WITHIN DESIGNATED STORMWATER CONTROL AREA: ® YES ® NO
IS THE PROPERTY LOCATED WITHIN ASA: ® YES ® NO PSSA: ® YES ® NO
IDATE: I STAFF:
METHOD OF PAYMENT:
VISA
CASH CHECK L ami
BANKCARD#; EXPIRES: VIN#
AUTHORIZED SIGNATURE.
*FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD
` ,
•
•
PLUMBING PERMIT APPLICATION
t(} City of Spokane Valley Community Development Department
BuildingDivision
Valley 11707 E. Sprague Avenue, Suite 106
4.00-
Spokane Valley, WA 99206
Phone: (509)688-0036;Fax: (509) 688-0037
14-7
'' 1 FOR INSPECTIONS, CALL(509)688-0054
Project Address: i—fl ( ` , ) ��� uJ1. Permit Use:
Owner: \c ._ C O m-' *- Phone (Daytime Contact): ` -ic/3
Mailing Address: X ��`� 1/422)
C ity State Zip Code
v
Contractor: Q;1'11Q 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 $6.00 =
3 TUBS X $6.00 =
4 SHOWERS(PER TRAP) BATH,STALL,ON-SITE BUILT 3 X $6.00 =
5 SINKS LAVSIBASINS,BAR,FLOOR,
KITCHEN,LAUNDRY,UTILITY, ' L X $6.00 =
JANITOR,PHOTO,X-RAY,FOOD,
PREP/CULINARY/MEAT
6 DISHWASHERi1 X $6.00 =
7 CLOTHES.WASHER 1 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, ,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 0 MASTERCARD PROCESSING FEE $35.00
DATE: EXPIRES: TOTAL PERMIT FEE DUE:
BANKCARD NUMBER:
AUTHORIZED SIGNATURE:
• . MECHANICAL PERMIT APPLICATION
SOU
ae'\...,„, City of Spokane Valley Community Development Department
BuildingDivision
%i1Ie
11707 E. Sprague Avenue, Suite 106
V Spokane Valley, WA 99206
4,,,, J Phone: (509)688-0036;Fax: (509)688-0037
-1 FOR INSPECTIONS, CALL(509)688-0054
Project Address: LP 1 -E i. `�Ph 7\f' Nl fie, Permit Use:
Owner: L\nC SQ of)St. Phone (Daytime Contact): 5- ( `/C?/3
Mailing Address: --i, 0. ?n X , n e w ' 9W.7$1.
City State Zip Code
Contractor: sC ANCt.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 1 X $10.00 =
16 MISC.FUEL BURNING APPLIANCEn X $10.00 =
17 GAS PIPING(each outlet) L x $1.00 =
16 DUCT SYSTEMS ' X $10.00 =
19 VENTILATING FANS 4 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 I 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 0 CHECK 0 VISA ❑MC DATE: PROCESSING FEE $35.00
CARD#: EXPIRES: TOTAL PERMIT FEE DUE:
AUTHORIZED SIGNATURE:
Air...rr.rr
Proposed Plot Plan
4715 East 13th Avenue
City of Spokane Valley
County of Spokane,State of Washington
LOT 3& A PORTION OF LOT 2, BLOCK 3, WOODLAND TERRACE
SCALE 1:20 I SEWER&WATER PROVIDED BY CITY OF SPOKANE
ADDRESS: -----------__-_--
ZONE:UR 3.5
ROAD WIDTH:60
'1./; / FRONT: _______FLANKING
FLANKING
COMMENTS:NTS:
(� ^ REVIEWED BY;--___---------.
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OP The site plan is being submitted for the purpose o1
Obtaining a building permit and is a true and correct
!Ir I k` K.presentation of the proposal. All known property
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I inns/dimensions,curb lines,structures and easements
C have been identified. Also indicted are wetlands,
-----E % -"bodies of water,steep slopes or other critical areas.
`\ I Lindsey Construction, Inc.
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