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2004, 01-20 Permit App: BLD-04-03419 Addition ary or odge\...., .00Va.lley PERMIT APPLICATION WORK SHEET SPOKANE VALLEY COMMUNITY DEVELOPMENT BUILDING DIVISION 11707 East Sprague Ave Ste 106 Spokane Valley, WA 99206 .. Phone:(509488--0036 Fax:(509)688-0037 REQUIRED SITE INFORMATION STREET ADDRESS: %7 a /`7 ASSESSOR'S TAX PARCEL NUMBER(S): LEGAL DISCRIPTION: 1 /6taik4vd7C��2 •i PERMIT DESCRIPTION: CI EUILDING PERMIT a CHANGE.IN USE a GRADING D MANUFACTURED HOME -RELOCATION• ®SIGN D TENANT E.OH1ER... { OWNER / APPLICANT INFORMATION ® OWNER: ./. CGtq CO PSI-- ® APPLICANT: PHONE: FAX: PHONE: FAX: ADDRESS: ADDRESS: CITY,STATE,ZIP . CITY,STATE,ZIP ®CONTRACTOR: a 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: BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP:. 2ND FLOOR SQ FT: BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT: NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT: NUMBER of BEDROOMS: CRITICAL AREAS: r` PAc E: FLANKING SETBACK: CURRENT PROPERTY SIZE: COVERED DECK: FRONT SETBACK: CURRENT PROPERTY USE: DECK: REAR SETBACK: CURRENT SEPTIC USE: LEFT SETBACK: CURRENT WELL USE: RIGHT SETBACK: IMPERVIOUS SURFACE AREA: 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: iRELOCATION FIRE SAFETY 1 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 j CI BOLTING ®CONCRETE 0 REINFORCEMENT ® WELDING FIRM NAME: PHONE: FAX: INSPECTOR(S): BUILDING STAFF USE ONLY 1 IS PUBLIC SEWER AVAILABLE: ® YES ® NO IF YES: 0 COUNTY 0 CITY - IS PUBLIC WATER AVAILABLE: ® 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: 0 YES 0 NO 11-15AfE7------1 STAFF: METHOD OF PA YMF_NT,' O 0 ® r . CASH CHECK L.1471 "1�_. SANKCARD#; EXPIRES: VINE` AUTHORIZED SIGNATURE:: *FAXED PERMIT APPLICATIONS WILL ONLY BE ACCEPTED WITH MAJOR BANKCARD oT4 ,/� 11707 East Sp;ague Avenue,Suite 106 509-688-0036-Phone 1S ,ne Spokane Valley,WA 99206 509-688-0037-Fax 4000 Valley For Inspections, call 509-688-0054 Plumbing Permit Application PROJECT PERMIT ADDRESS: /71 g /31-47 USE: k// OWNER: 'iC r1 C/TG'r e1.- PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) CONTRACTOR: LICENSE#: MAILING ADDRESS: PHONE#: (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- / 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 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 X $6 - R.P.B.P.D.FOR:VATS,TANKS,BOILERS 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 VISA- !Vase-f... PLUS PROCESSING FEE: $35.00 0 CASH 0 CHECK ❑ ❑ '-.-- - - ,._ TOTAL PERMIT FEE DUE: DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: K- l3TT of 11707 East Sprague Ate;nue,Suite 106 509-688-0036-Phone n� �► Spokane Valley,WA 99206 509-688-0037-Fax 4000VdlleY For Inspections, call 509-688-0054 Mechanical Permit Application PROJECT PERMIT ADDRESS: USE: OWNER: PHONE(Daytime Contact): MAILING ADDRESS: (street) (city/state) (ZIP) CONTRACTOR: LICENSE#: MAILING ADDRESS: PHONE#: (street) (city/state) (ZIP) DESCRIPTION OF WORK 9 OF tm/ITS 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 4-1750M 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. — X $10 = 17 GAS PIPING(ea.Outlet) — X $1 = 18 DUCT SYSTEMS — X $10 - 19 VENTILATING FANS — ( X $10 = I co wt.)20 AIR HANDLER(DOES NOT include ducting) =OR<10,000CFM X $12 = I 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 PAYMENTPLUS PROCESSING FEE: $35.00 ginilii _ VISA } TOTAL PERMIT FEE DUE: ElCASH ❑ CHECK ❑ iiiiiinit ❑ _ DATE: EXPIRES: BANKCARD NUMBER: AUTHORIZED SIGNATURE: